紫杉醇加卡铂与吉西他滨为基础联合化疗序贯用药对降低上皮性卵巢癌复发的临床研究

发布时间：2018-12-13 02:08

【摘要】：目的探讨紫杉醇加卡铂与吉西他滨为基础的联合化疗序贯用药对预防上皮性卵巢癌耐药的临床价值。方法分析2005年4月至2011年6月山东省肿瘤医院经手术病理分期确定为Ⅲc期的按标准纳入的初治手术后上皮性卵巢癌患者的临床病理及随访资料,共121例,其中59例应用紫杉醇加卡铂化疗4个周期,然后调整为以吉西他滨为基础的联合化疗用药2~4个周期(序贯化疗组),62例常规应用紫杉醇加卡铂持续化疗6~8个周期(常规化疗组),观察两组患者的反应率、复发率、化疗毒副反应、无进展生存期(PFS)、复发后生存期和总生存率。结果截至2011年12月31日,序贯化疗组中位随访时间为39个月(4~73个月),常规化疗组为41个月(3~69个月)。序贯化疗组的完全缓解率(CR)、部分缓解率(PR)和总缓解率(CR+PR)分别为58.4%、24.3%和82.7%,常规化疗组为59.5%、27.1%和86.6%,组间比较,差异无统计学意义(P0.05)。序贯化疗组中位无进展生存期28个月(6~62个月),明显高于常规化疗组的18个月(4~57个月),差异有统计学意义(P=0.037)。序贯化疗组复发率44.6%(25/56),常规化疗组复发率55.2%(32/58),两组比较差异无统计学意义(P=0.322)。复发后生存期两组分别为24个月(8~38个月)及19个月(6~33个月),组间比较差异无统计学意义(P=0.114)。序贯化疗组患者1年、3年无进展生存率分别为87.5%和35.7%,明显高于常规化疗组(72.4%和24.1%),差异具有统计学意义(P=0.022);序贯化疗组5年总生存率32.2%,显著高于常规化疗组的18.6%(P=0.014)。但5年无进展生存率及1年、3年总生存率两组间差异均无统计学意义(P0.05)。血液系统化疗主要毒性反应两组均为骨髓抑制,两组发生率差异无统计学意义(P0.05);非血液系统化疗毒性反应主要为神经系统毒性反应,序贯化疗组发生3~4级神经系统毒性发生率显著低于常规化疗组(3.3%vs.14.5%,P=0.016)。结论上皮性卵巢癌减瘤术后紫杉醇加卡铂用药4个周期后调整为吉西他滨为主的化疗方案,可提高患者的PFS、延缓复发、提高近期无进展生存率及远期总生存率,且毒性反应少,有临床推广价值。
[Abstract]:Objective to investigate the clinical value of paclitaxel plus carboplatin and gemcitabine combined chemotherapy in the prevention of epithelial ovarian cancer resistance. Methods from April 2005 to June 2011, 121 cases of epithelial ovarian cancer after primary operation were included in Shandong Cancer Hospital. 59 cases were treated with paclitaxel plus carboplatin for 4 cycles, then adjusted to gemcitabine based combined chemotherapy for 2 ~ 4 cycles (sequential chemotherapy group). 62 patients were treated with paclitaxel plus carboplatin for 6 ~ 8 cycles (conventional chemotherapy group). The response rate, recurrence rate, side effects of chemotherapy, survival time and overall survival rate after recurrence of (PFS), were observed. Results as of December 31, 2011, the median follow-up time was 39 months (4 ~ 73 months) in sequential chemotherapy group and 41 months (3 ~ 69 months) in routine chemotherapy group. The complete remission rate (CR),) partial remission rate (PR) and total remission rate (CR PR) were 58.4% and 82.7% in sequential chemotherapy group, and 59.5% and 86.6% in routine chemotherapy group, respectively. The difference was not statistically significant (P0.05). The median progression-free survival time of sequential chemotherapy group was 28 months (6 ~ 62 months), which was significantly higher than that of routine chemotherapy group in 18 months (4 ~ 57 months). The difference was statistically significant (P0. 037). The recurrence rate was 44.6% (25 / 56) in sequential chemotherapy group and 55.2% (32 / 58) in routine chemotherapy group. The survival time of the two groups was 24 months (8 ~ 38 months) and 19 months (6 ~ 33 months) respectively. There was no significant difference between the two groups (P < 0. 114). The 1-year and 3-year progression-free survival rates in sequential chemotherapy group were 87.5% and 35.775%, respectively, which were significantly higher than those in routine chemotherapy group (72.4% and 24.1%), and the difference was statistically significant (P0. 022). The 5-year overall survival rate in sequential chemotherapy group was 32.2%, which was significantly higher than that in routine chemotherapy group (18.6%) (P0. 014). But there was no significant difference in 5-year progression-free survival rate and 1-year and 3-year overall survival rate between the two groups (P0.05). The main toxicity of chemotherapy in blood system was bone marrow suppression in both groups, and there was no significant difference in the incidence between the two groups (P0.05). The incidence of neurotoxicity in the sequential chemotherapy group was significantly lower than that in the conventional chemotherapy group (3.3vs.14.5). Conclusion adjusting paclitaxel plus carboplatin to gemcitabine chemotherapy regimen after 4 cycles of treatment for epithelial ovarian cancer can improve the PFS, recurrence, improve the short-term progression-free survival rate and long-term overall survival rate in patients with epithelial ovarian cancer after treatment with paclitaxel plus carboplatin for 4 cycles. And the toxicity reaction is few, has the clinical popularizing value.
【作者单位】：山东省肿瘤医院;
【基金】：国家自然科学基金(30901713) 山东省自然科学基金(ZR2009CQ019);山东省自然科学基金(BS2010YY065)
【分类号】：R737.31

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