国际肿瘤学杂志

国际肿瘤学杂志››2023,Vol. 50››Issue (6): 342-347.doi:10.3760/cma.j.cn371439-20230116-00068

• 论著 •上一篇下一篇

二次肿瘤细胞减灭术治疗初始减瘤手术不满意铂敏感复发性卵巢癌的预后及影响因素分析

李晨曦1, 赵宏伟2()

  1. 1山西医科大学第二临床医学院，太原 030001
    2山西省肿瘤医院妇二科，太原 030001
  • 收稿日期:2023-01-16修回日期:2023-02-18出版日期:2023-06-08发布日期:2023-07-11
  • 通讯作者:赵宏伟，Email： inmind20060829@126.com

Prognosis and influencing factors of platinum sensitive recurrent ovarian cancer treated by secondary cytoreduction surgery in patients with unsatisfactory primary cytoreduction surgery

Li Chenxi1, Zhao Hongwei2()

  1. 1Second Clinical College，Shanxi Medical University，Taiyuan 030001，China
    2Department of Second Gynecology，Shanxi Provincial Cancer Hospital，Taiyuan 030001，China
  • Received:2023-01-16Revised:2023-02-18Online:2023-06-08Published:2023-07-11
  • Contact:Zhao Hongwei，Email： inmind20060829@126.com

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摘要：

目的探讨二次肿瘤细胞减灭术（SCS）治疗初始减瘤手术不满意铂敏感复发性卵巢癌患者的预后及影响因素。方法回顾性分析2005年1月至2018年12月于山西省肿瘤医院行首次复发治疗的116例初始减瘤手术不满意铂敏感复发性卵巢癌患者的临床资料，其中33例接受SCS+化疗，83例接受了单纯化疗。为消除两组患者一般临床资料的组间差异，通过倾向评分匹配从两组患者筛选出28对56例组成匹配队列并对其进行数据分析。主要观察指标为治疗后的无进展生存期（PFS）和总生存期（OS）。采用Kaplan-Meier法绘制生存曲线并行log-rank检验，采用Cox回归模型分析初始减瘤手术不满意铂敏感复发性卵巢癌患者的预后影响因素。结果经匹配后的56例初始减瘤手术不满意的铂敏感复发性卵巢癌患者中位PFS为9.0个月，半年、1年PFS率分别为67.9%、25.0%；中位OS为57.5个月，3年、5年OS率分别为60.7%、39.3%。其中，SCS+化疗患者和单纯化疗患者中位PFS分别为10.5个月、7.5个月，半年、1年PFS率分别为82.1%比57.1%、32.1%比21.4%，差异有统计学意义（χ2=3.88，P=0.049）；SCS+化疗患者和单纯化疗患者中位OS分别为70.0个月、60.0个月，3年、5年OS率分别为88.5%比64.3%、70.0%比53.0%，差异无统计学意义（χ2=3.63，P=0.057）。单因素分析显示，国际妇产科联盟（FIGO）分期（HR=3.17，95%CI为1.32~7.59，P=0.010）、无铂治疗间期（TFIp）（HR=0.35，95%CI为0.18~0.68，P=0.002）均为影响初始减瘤手术不满意铂敏感复发性卵巢癌患者PFS的独立影响因素；糖类抗原125（HR=2.46，95%CI为1.21~5.00，P=0.013）为初始减瘤手术不满意铂敏感复发性卵巢癌患者OS的独立影响因素。多因素分析显示，FIGO分期（HR=2.95，95%CI为1.18~7.36，P=0.020）、TFIp（HR=0.33，95%CI为0.16~0.66，P=0.002）均为影响初始减瘤手术不满意铂敏感复发性卵巢癌患者PFS的独立预后因素。结论对于初始减瘤手术不满意减瘤，但经过术后化疗达到临床完全缓解的铂敏感复发性卵巢癌患者，行SCS或可延长其治疗后的PFS，接受治疗后的OS亦有获益趋势，但其差异并无统计学意义，FIGO分期、首次复发前TFIp是影响初始减瘤手术不满意铂敏感复发性卵巢癌患者PFS的独立预后因素。

关键词:卵巢肿瘤,肿瘤细胞减灭术,药物疗法,预后

Abstract:

ObjectiveTo investigate the prognosis and influencing factors of secondary cytoreduction surgery （SCS） in patients with platinum-sensitive recurrent ovarian cancer whose tumor reduction with unsatisfactory primary cytoreduction surgery.MethodsThe clinical and follow-up data of 116 patients with platinum-sensitive recurrent ovarian cancer whose tumor reduction with unsatisfactory primary cytoreduction surgery and received the first diagnosis and operation in Shanxi Provincial Cancer Hospital from January 2005 to December 2018 were retrospectively analyzed. Among them，33 patients received SCS+chemotherapy and 83 patients received chemotherapy alone. In order to eliminate the component differences in general clinical data between the two groups，28 pairs total 56 patients were selected from each group to form a matching cohort by propensity score matching，and their data were analyzed. The main outcome measures were progression-free survival （PFS） and overall survival （OS）. Kaplan-Meier method was used to draw the survival curve accompanied with log-rank test. Cox regression model was used to analyze the prognostic factors of patients with platinum-sensitive recurrent ovarian cancer whose tumor reduction with unsatisfactory primary cytoreduction surgery.ResultsThe median PFS of 56 matched patients with platinum-sensitive recurrent ovarian cancer whose tumor reduction with unsatisfactory primary cytoreduction surgery was 9.0 months. The 0.5- and 1-year PFS rates were 67.9% and 25.0% respectively. The median OS of 56 patients was 57.5 months. The 3- and 5-year OS rates were 60.7% and 39.3% respectively. The median PFS was 10.5 months in the SCS+chemotherapy patients and 7.5 months in the chemotherapy alone patients，and the 0.5- and 1-year PFS rates were 82.1%vs.57.1% and 32.1%vs.21.4% respectively，with a statistically significant difference （χ2=3.88，P=0.049）. The median OS was 70.0 months in the SCS+chemotherapy patients，and 60.0 months in the chemotherapy alone patients，and the 3- and 5-year OS rates of the SCS+chemotherapy patients and chemotherapy alone patients were 88.5%vs.64.3% and 70.0%vs.53.0%，with no statistically significant difference （χ2=3.63，P=0.057）. Univariate analysis showed that International Federation of Gynecology and Obstetrics （FIGO） staging （HR=3.17，95%CI：1.32-7.59，P=0.010） and treatment-free interval from the last platinum （TFIp）（HR=0.35，95%CI：0.18-0.68，P=0.002） were independent influencing factors of PFS in patients with platinum-sensitive recurrent ovarian cancer whose tumor reduction with unsatisfactory primary cytoreduction surgery. Carbohydrate antigen 125 （HR=2.46，95%CI：1.21-5.00，P=0.013） was an independent influencing factor of OS in patients with platinum-sensitive recurrent ovarian cancer whose tumor reduction with unsatisfactory primary cytoreduction surgery. Multivariate analysis showed that FIGO staging （HR=2.95，95%CI：1.18-7.36，P=0.020） and TFIp （HR=0.33，95%CI：0.16-0.66，P=0.002） were independent prognostic factors of PFS.ConclusionFor platinum-sensitive recurrent ovarian cancer patients who do not achieve satisfactory tumor reduction after primary cytoreduction surgery，but achieve clinical complete response after postoperative chemotherapy，SCS may prolong their PFS after treatment，and OS also shows a beneficial trend after treatment，but with no statistically significant difference. FIGO staging at initial treatment and TFIp before the first relapse are independent prognostic factors of PFS in patients with platinum-sensitive recurrent ovarian cancer whose tumor reduction with unsatisfactory primary cytoreduction surgery.

Key words:Ovarian neoplasms,Cytoreduction surgical procedures,Drug therapy,Prognosis