二次肿瘤细胞减灭术在铂类敏感的复发性卵巢癌中作用的系统评价

发布时间：2018-03-04 08:35

本文选题：二次肿瘤细胞减灭术　切入点：复发性卵巢癌　出处：《吉林大学》2017年硕士论文　论文类型：学位论文

【摘要】：目的:卵巢癌是女性常见肿瘤,80%~90%患者在初始治疗后可达到临床缓解,但仍有60%~70%的患者最终复发,复发后的治疗尚无统一标准。现有研究支持二次肿瘤细胞减灭术可延长铂类敏感的复发性卵巢癌患者总生存期,但大部分的为回顾性研究,部分为前瞻性试验,仅有的随机对照试验正在进行。本文收集已发表的关于二次肿瘤细胞减灭术在铂类敏感复发性卵巢癌患者中作用的相关研究,系统评价二次肿瘤细胞减灭术对比单纯化疗对复发性卵巢癌患者生存期的影响,及二次肿瘤细胞减灭术后达到无肉眼残留肿瘤对比有任何体积的残留肿瘤对复发性卵巢癌患者生存期的影响。方法:计算机检索Cochrane图书馆、Pub Med、Embase、Clinicaltrials、中国生物医学文献数据库(CBM)、相关期刊论文(CNKI)、万方数据库,手工检索所有当前能够检索到的参考资料及研究报告,检索时间均从建库至2016年10月。由2位评价员独立筛选文献、提取资料并评价纳入研究的偏倚风险后,采用Rev Man 5.3软件进行Meta分析。结果:最终纳入21篇研究,5375例患者。纳入研究进行定性分析:平均年龄55.41岁,平均随访时间为36.96个月,复发前的平均中位无进展生存期为20.95个月,术后平均中位生存时间为35.01个月,平均中位无进展生存期为18个月,手术时间247分钟(26-600分钟),术中出血量524ml(50-6000ml),无肉眼残留肿瘤手术切除率为57.72%(38%-82.1%),满意肿瘤细胞减灭术手术切除率为70.35%(38.3%-89.36%),手术并发症发生率为4.1%-43.3%,手术死亡率为1.12%。Meta分析结果显示:与单纯化疗相比,二次肿瘤细胞减灭术能够延长具有有利预后因素的复发性卵巢癌患者的总生存期(HR=1.34,95%CI(1.22-1.46),P0.00001)。总生存期比较亚组分析结果提示,二次肿瘤细胞减灭术后残留肿瘤(RD)0cm对比RD=0cm,HR=3.10,95%CI(2.25-4.27),P0.0001;RD≤0.5cm对比RD=0cm,HR=2.86,95%CI(1.38-5.90),P=0.0.005;RD≤1.0cm对比RD=0cm,HR=2.91,95%CI(2.36-3.59),P0.00001;RD1.0cm对比RD=0cm,HR=5.86,95%CI(4.42-7.77),P0.00001;RD2.0cm对比RD=0cm,HR=2.56,95%CI(1.45-4.52),P=0.001。合并亚组Meta分析结果提示,与二次肿瘤细胞减灭术达到无任何体积残留肿瘤相比,达到无肉眼残留肿瘤的手术可延长手术患者的生存期(HR=3.37,95%CI 2.84-3.99,P0.00001)。纳入研究中仅有2项对比二次肿瘤细胞减灭术与单纯化疗患者的生存质量,均提示手术对复发患者的生存质量的并无影响。结论:1.二次肿瘤细胞减灭术及术后继续化疗可延长具有良好预后因素的铂类敏感复发性卵巢癌患者的总生存期,且具备的有利预后因素越多,达到满意程度的二次肿瘤细胞减灭术的比率就越高,但尚无统一的手术风险预测或评分模型,因此在为复发患者选择治疗方案时,仍需综合评定做出个体化的选择。2.达到无肉眼可见残留肿瘤的二次肿瘤细胞减灭术可显著延长复发性卵巢癌手术患者的总生存期,故在术中应尽可能减灭所有肉眼可见肿瘤,使手术达到无肉眼可见残留肿瘤的满意手术效果,若不能达到则应减灭肿瘤残留体积于1cm内,才能使患者获得相对较长的生存时间。3.评价二次肿瘤细胞减灭术在复发性卵巢癌的作用的随机对照试验正在进行,全面对比二次肿瘤细胞减灭术与单纯化疗的有效性、安全性以及生存质量方面的差异,其数据及结论值得期待,可为二次肿瘤细胞减灭术在复发性卵巢癌患者中的作用提供更有力的证据支持。
[Abstract]:Objective: ovarian cancer is the most common cancer in women, 80%~90% patients reached clinical remission after initial therapy, but there are still 60%~70% patients eventually relapse, relapse after treatment has no uniform standards. The existing research supports two cytoreductive surgery can prolong the platinum sensitive recurrent total survival of patients with ovarian cancer, but most of the retrospective study is a prospective trial, a randomized controlled trial only is being carried out. This paper collects relevant published research on two tumor cell killing effect in the reduction of platinum sensitive recurrent ovarian cancer patients, system two evaluation of influence of tumor cell surgical debulking compared to chemotherapy alone in the treatment of recurrence ovarian cancer survival, and two times of cytoreductive surgery after reaching no gross residual tumor compared with the effect of the residual tumor volume of any recurrent ovarian cancer survival. Methods: A computer search of the Cochrane library, Pub Med, Embase, Clinicaltrials, Chinese biomedical literature database (CBM), China Journal Full-text Database (CNKI), Wanfang database, manual retrieval of all current access to reference and research reports, were searched from inception to October 2016. By 2 reviewers independently screened the literature. Extracted the data and assessed the risk of bias of included studies, using Rev Man 5.3 software for Meta analysis. Results: a total of 21 studies, 5375 patients were included in the study. Qualitative analysis: the average age of 55.41 years, the average follow-up time was 36.96 months, the average recurrence before the median progression free survival was 20.95 in August, the average postoperative median survival time was 35.01 months, median progression free survival was 18 months. The operative time was 247 minutes (26-600 minutes), the intraoperative blood loss was 524ml (50-6000ml), no gross residual tumor The resection rate was 57.72% (38%-82.1%), satisfactory cytoreductive resection rate was 70.35% (38.3%-89.36%), the complication rate was 4.1%-43.3%, the mortality rate of operation was 1.12%.Meta analysis results showed that: compared with chemotherapy, two secondary cytoreductive surgery can prolong overall survival with favorable prognosis in patients with recurrent ovarian cancer the factors (HR=1.34,95%CI (1.22-1.46), P0.00001). The total survival time between subgroup analysis showed that the two tumor cell reduction of residual tumor after cytoreductive surgery (RD) 0cm compared to RD=0cm, HR=3.10,95%CI (2.25-4.27), P0.0001; RD = 0.5cm (1.38-5.90) compared to RD=0cm, HR=2.86,95%CI, P=0.0.005; RD = 1.0cm RD=0cm (2.36-3.59), HR=2.91,95%CI, P0.00001; RD1.0cm compared to RD=0cm, HR=5.86,95%CI (4.42-7.77), P0.00001; RD2.0cm HR= 2.56,95%CI RD=0cm comparison (1.45-4.52), P=0.001. and Meta subgroup analysis showed that with the Two cytoreductive surgery achieved no residual tumor volume compared to no gross residual tumor surgical operation can prolong the survival of patients (HR=3.37,95%CI, 2.84-3.99, P0.00001). The quality of life in the study included only 2 compared to two secondary cytoreductive surgery and chemotherapy patients, showed that the operation had no effect the quality of life of patients with recurrence. Conclusion: 1. two tumor cells reduced overall survival after surgery and chemotherapy to destroy can prolong the good prognostic factors for platinum sensitive recurrent ovarian cancer patients, more favorable prognostic factors and have reached two times, the degree of satisfaction of reducing the ratio of tumor cells out of the higher, but the operation risk prediction score model or there is no uniform, so the treatment options for patients with recurrent, still need to make a choice of comprehensive evaluation of individual.2. reached no visible residual swelling Two tumor cell tumor cytoreductive surgery can significantly prolong overall survival of recurrent ovarian cancer patients, so as to eliminate all visible tumor should be in operation, the operation achieves satisfactory surgical results no visible residual tumor, if it can not reach should cytoreductive tumor residual volume in 1cm that can make the patient obtain relatively long survival time of.3. tumor cell reduction two evaluation of randomized controlled trials of cytoreductive surgery in recurrent ovarian cancer: role of ongoing, comprehensive comparison of the two tumor cell reduction effectiveness of cytoreductive surgery and chemotherapy, differences in safety and quality of life, the data and conclusions it is worth looking forward to but, cytoreductive surgery in patients with recurrent ovarian cancer in the role to provide more effective support for the two tumor cells.

【学位授予单位】：吉林大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R737.31

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