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目的:分析晚期卵巢上皮癌的耐药情况及复发后治疗,探讨化疗敏感性对预后的影响。方法:按初治后的无瘤间期(disease free interval,DFI)将176例患者分为R组(铂耐药,DFI<6个月)和S组(铂敏感,DFI>6个月)两组,S组再分为S1组(铂部分敏感,DFI为6～12个月)和S2组(铂敏感,DFI>12个月)两组,分析各组患者的临床特征、复发情况、复发后治疗及预后。结果:176例晚期卵巢上皮癌,平均发病年龄54.01±10.19(23～77)岁,69.3%为浆液性,71.6%为低分化,淋巴转移率42.8%,30.1%原发耐药,总5年生存率45.4%,中位OS为56个月,中位PFS为24个月。R组(铂耐药)和S2组(铂敏感)的中位OS和PFS有显著差异,S1组的中位OS及中位PFS分别为40和17个月,介于铂耐药、铂敏感之间。S1组的肿瘤、术前CA125、盆腔腹主动脉旁淋巴结转移率也介于铂耐药以及铂敏感患者之间,其初次手术达满意肿瘤减灭的比例为13.8%,显著低于铂敏感者(29.8%)(P=0.047)。铂部分敏感患者复发后,更换化疗方案者中位OS较继续使用TC/TP或CAP化疗者略长,但无统计学意义(P=0.081)。结论:将铂部分敏感患者单独分类有意义,此类患者复发后的治疗措施尚无定论,有待进一步研究。
OBJECTIVE: To analyze the drug resistance of advanced epithelial ovarian cancer and the treatment after relapse, and to explore the effect of chemosensitivity on the prognosis. Methods: 176 patients were divided into group R (platinum resistance, DFI <6 months) and group S (platinum sensitive, DFI> 6 months) according to the initial disease free interval (DFI) Two groups, S group were further divided into two groups: S1 group (partial platinum sensitive, DFI 6-12 months) and S2 group (platinum sensitive, DFI> 12 months). The clinical characteristics, recurrence, Post-relapse treatment and prognosis. Results: Of the 176 patients with advanced epithelial ovarian cancer, the average age of onset was 54.01 ± 10.19 (range, 23-77) years, 69.3% were serous, 71.6% were poorly differentiated, lymphoid metastasis rate was 42.8%, and primary drug resistance was 30.1% The survival rate was 45.4%, the median OS was 56 months and the median PFS was 24 months. The median OS and PFS in group R (platinum resistance) and group S2 (platinum sensitive) were significantly different. The median OS and median PFS in group S1 were 40 and 17 months, respectively, which were between platinum resistance and platinum sensitivity between. The tumor of S1 group, preoperative CA125, para-aortic lymph node metastasis rate were also between platinum-resistant and platinum-sensitive patients, and the rate of satisfactory tumor reduction in primary surgery was 13.8%, which was significantly lower than that in platinum-sensitive patients (29.8%) (P = 0.047). After relapse, the median OS of patients who switched to chemotherapy regimen was slightly longer than that of patients who continued to use TC / TP or CAP chemotherapy. However, the median OS was not statistically significant (P = 0.081). Conclusion: The classification of platinum-sensitive patients alone is meaningful, the treatment of these patients after relapse is inconclusive, pending further study.