【作者】 余冬青；

【导师】 李力； 陈心秋； 李菲； 张洁清；

【作者基本信息】 广西医科大学 ， 妇科肿瘤， 2004， 硕士

【摘要】 卵巢癌是妇科肿瘤中死亡率最高的恶性肿瘤。许多卵巢上皮性癌在诊断时就已经是晚期。虽然肿瘤细胞减灭术和规则化疗已经成为标准的卵巢癌治疗措施，卵巢癌总的5年生存率仍只有30%左右。本研究就卵巢癌治疗中初次手术腹膜后淋巴结清扫、晚期卵巢癌先期化疗、复发性卵巢癌再次手术和二线化疗热点问题进行临床及循证医学研究。临床数据来自广西肿瘤医院妇瘤科，同时对以上问题做循证医学研究。影响卵巢恶性肿瘤预后的多因素分析目的：探讨卵巢癌的预后因素。方法：对1985-1998年间在广西肿瘤医院妇瘤科治疗的313例卵巢癌患者进行回顾性研究。用Kaplan-Meier法算生存率，差异性用Log-rank test进行比较。独立的预后因素用COX逐步回归模型确定。结果：多因素分析显示临床期别、残余灶、腹膜后淋巴结清扫和化疗疗程是重要的预后因素。卵巢恶性肿瘤腹膜后淋巴结清扫临床价值的循证医学研究 目的：探讨卵巢恶性肿瘤腹膜后淋巴结清扫的临床价值。方法：对1985-2002年间在广西肿瘤医院妇瘤科治疗的361例卵巢上皮性癌患者进行回顾性研究。同时进行初次手术腹膜后淋巴结清扫的循证医学评价。结果：行淋巴清扫组和不行淋巴结清扫组的患者5年生存率分别为56.6%、48.2%，p<0.05。早期卵巢癌行腹膜后淋巴结清扫并不能提高生存率，P >0.05。晚期进行腹膜后淋巴结清扫的患者中，残余灶＜2cm和≥2cm的5年生存率分别为76.5%和38.5%，p<0.05。多因素分析显示：临床期别、残余灶、腹膜后淋巴清扫和化疗疗程是卵巢癌上皮性癌的独立预后因素。结论：虽然腹膜后淋巴结清扫可以改善卵巢癌患者生存率，但是建议有选择的进行。然而，循证医学证据显示腹膜后淋巴结清扫术有利于早期、晚期卵巢癌的预后。卵巢恶性肿瘤先期化疗临床价值的循证医学研究目的：研究先期化疗对晚期卵巢上皮性癌预后的影响。方法：对1985-1998年间在广西肿瘤医院妇瘤科治疗的94例晚期卵巢上皮性癌患者进行回顾性研究，对其中68例未行先期化疗，直接进行传统的手术+辅助化疗和26例行先期化疗后手术的患者进行远期预后<WP=7>的调查。同时进行先期化疗的循证医学研究。结果：94例晚期卵巢上皮性癌中，行先期化疗组和未行先期化疗组的5年生存率分别是21.6%和21.3%，没有统计学上差异，p>0.05。但是先期化疗组中，术后残余灶<2cm预后好于残余灶≥2cm的，P<0.05。多因素分析显示先期化疗不是晚期卵巢上皮性癌的独立预后因素。结论：先期化疗组中术后残余灶<2cm的预后好于残余灶≥2cm。循证医学证据表明证据还不足以充分说明先期化疗对卵巢癌术后的影响，其原因是与存在发表的偏倚和方法学质量低下的问题有关。复发性卵巢癌再次手术临床价值的循证医学研究目的：评价复发性卵巢上皮性癌再次手术的价值。方法：对1985-1998年间在广西肿瘤医院妇瘤科治疗的43例复发性卵巢上皮性癌患者进行回顾性研究，同时进行循证医学研究。结果：43例晚期卵巢上皮性癌中行再次手术者和行二线化疗者的生存率没有统计学上差异，p>0.05。循证医学证据表明：再次手术对于铂类敏感、局限性复发的患者有意义。结论：再次手术对于复发性卵巢上皮性癌远期的预后仍不能定论。因为随机对照试验是不人道的。为了改善复发性卵巢上皮性癌的预后和提高生存率，最佳的挽救治疗方法仍需要进一步研究，包括选择最佳的时机和方式完成再次肿瘤细胞减灭术。复发性卵巢癌二线化疗临床价值的循证医学研究目的：评价复发性卵巢上皮性癌二线化疗的价值。方法：对1985-1998年间在广西肿瘤医院妇瘤科治疗的25例复发性卵巢上皮性癌患者进行回顾性研究，同时进行循证医学研究。结果：25例复发性卵巢上皮性癌二线化疗预后与复发时间相关。二线化疗方案的选择及预后与是否铂类化疗敏感有关，应该根据累积毒性和临床表现进行个性化治疗。紫杉醇和卡铂/顺铂的方案是目前铂类敏感首选联合化疗方案，但是总的生存率仍不高。循证医学证据表明：铂类敏感型复发性卵巢上皮癌首选铂类化疗效果好。结论：复发性卵巢上皮性癌二线化疗应遵循个性化原则。为了改善复发性卵巢上皮性癌的预后和提高生存率，最佳的挽救治疗方法仍需要进一步研究，包括新的二线化疗药物的开发和新的联合治疗方法。更多还原

【Abstract】 Ovarian cancer is the most common cause of female cancer mortality in women. Most patients with epithelial ovarian carcinoma present with advanced disease at the time of diagnosis. Although primary cytoreductive surgery or debulking procedure followed by systemic chemotherapy is the standard treatment protocol used in the management of ovarian cancer, the overall five-years survival is only about 30%. This study is to evaluate several “hotspot” of treatments for ovarian carcinoma, such as retroperitoneal lymphadenectomy in first cytoreductive surgery, neoadjuvant chemotherapy in patients with advanced epithelial ovarian carcinoma, secondary cytoreductive surgery and second-line chemotherapy in patients with recurrent epithelial ovarian carcinoma. It comprises data on ovarian cancer from the Department of female tumor of Guangxi Tumor Hospital and a large number of studies in ovarian cancer have been reviewed following the standard of evidenced-based medicineAnalysis prognostic factors of ovarian cancerOBJECTIVE: The purpose of this study was to determine prognostic factors that have an impact on overall survival. METHODS: A retrospective review was performed of 313 patients treated between 1985 and 1998 at the Department of female tumor of Guangxi Tumor Hospital. Survival was calculated by Kaplan-Meier method and comparison was performed using Log-rank test. Independent prognostic factors were identified by the COX proportional hazards regression model. RESULTS: Multivariate analysis showed that stage, the size of residual tumor, retroperitoneal lymphadenectomy and the number of courses of chemotherapy were the most important prognostic factors.Evidence-based research on clinical value of retroperitoneal lymphadenectomy for ovarian cancerOBJECTIVE: To explore the clinical value of retroperitoneal lymphadenectomy for ovarian cancer. METHODS: A retrospective review was performed of 361 patients treated between 1985 and 2002 at the Department of female tumor of Guangxi Tumor Hospital. On the other hand, a large number of studies on retroperitoneal lymphadenectomy in first cytoreductive surgery have <WP=9>been reviewed. RESULTS: The overall 5-year survival was 56.6% and 48.2% for patients who did and did not undergo lymphadenectomy, respectively (P < 0.05). But the survival rate could not be improved through retroperitoneal lymphadenectomy in the patients with early stage (P > 0.05). Among patients with advanced stage who undergo lymphadenectomy , 5-year survival was 76.5% and 38.5% for patients whose size of residual tumor < 2 cm and >r =2cm, respectively (P < 0.05). Multivariate analysis showed that stage, residual tumor, retroperitoneal lymphadenectomy and the number of courses of chemotherapy is the prognostic factors in patients with epithelial ovarian cancer. CONCLUSIONS: Although retroperitoneal lymphadenectomy could improve the survival rate, it should be carried out selectively. However, there is evidence-based result showed that retroperitoneal lymphadenectomy could improve survival rate to a patient with early stage and advanced stage carcinoma.Evidence-based research on clinical value of neoadjuvant chemotherapy for ovarian cancerOBJECTIVE : The purpose of this study was to assess the survival benefit of neoadjuvant chemotherapy (NAC) in patients with FIGO stage Ⅲ or IV epithelial ovarian cancer. METHODS: In patients treated for stage Ⅲ or IV ovarian epithelial malignancies at the Department of female tumor of Guangxi Tumor Hospital between 1985 and 1998, 94 patients had a diagnosis of advanced ovarian carcinoma. For this group, the long-term outcome was compared between 68 patients receiving conventional adjuvant chemotherapy following standard surgery and 26 patients treated with NAC followed by a cytoreductive surgery. On the other hand, a large number of studies on neoadjuvant chemotherapy in stage Ⅲ or IV epithelial ovarian cancer have been reviewed. RESULTS: In a total of 94 patients with histologic types of epithelial ovarian malignancy, the overall 5-year survival was 21.6% a更多还原