腹腔热灌注化疗在晚期卵巢上皮性癌中的疗效分析

发布时间：2018-07-10 03:46

本文选题：卵巢上皮癌 + 肿瘤细胞减灭术　；参考：《郑州大学》2017年硕士论文

【摘要】：背景与目的卵巢癌(ovarian cancer,OC)是女性生殖系统最常见的恶性肿瘤之一,其发病率仅次于宫颈癌、子宫内膜癌,但死亡率居妇科恶性肿瘤首位。卵巢上皮性肿瘤是最常见的卵巢肿瘤,占卵巢恶性肿瘤85%～90%,严重威胁女性健康。根据2015年NCCN指南指出晚期上皮性卵巢癌标准治疗是满意的肿瘤细胞减灭术(尽可能切除肉眼可见的所有病灶,使残余癌灶1cm),获得全面分期,术后给予足够疗程的化疗、放疗、生物治疗等综合治疗。目前手术仍是卵巢癌的首要治疗方法,但晚期卵巢癌已发生腹腔内广泛转移和弥漫种植,满意的肿瘤细胞减灭术后仍有较小的残余病灶和癌细胞。虽然大多数卵巢癌患者对以铂类为主的化疗药物相对敏感,但由于血液-腹膜屏障的存在术后静脉化疗很难达到腹腔内药物浓度,疾病预后较差,复发率高。腹腔化疗是将化疗药物直接放置腹腔内,增加药物与恶性肿瘤的接触面积,提高局部药物浓度,显著提高疗效。腹腔热灌注化疗已在胃肠道肿瘤的治疗中发挥了很好的疗效,通过对肿瘤局部加温,使之达到一定温度持续一定时间,既能杀灭肿瘤细胞,又不损害正常组织,达到治疗肿瘤的目的。近年来,腹腔热灌注化疗联合静脉化疗的临床应用逐渐增多,但关于灌注药物及灌注时间尚无统一标准,本研究对卵巢癌术后腹腔热灌注联合静脉化疗临床疗效及安全性进一步研究,为晚期卵巢癌提供更多的治疗方法。资料与方法1.资料来源:分析74例2011年01月～2015年06月就诊于郑州大学第二附属医院收治的临床诊断III期～IV期的晚期上皮性卵巢癌患者,将74例晚期卵巢癌患者分为两组:试验组35例(术后行腹腔热灌注化疗联合静脉化疗);对照组39例(术后行静脉化疗)。观察两种治疗方式的近期疗效和化疗毒副反应,并对两组生存情况进行对比,探讨腹腔热灌注化疗在晚期上皮性卵巢癌中的临床价值。2.统计学方法:采用SPSS17.0软件分析,计量资料采用均数±标准差(?x±s)表示,采用t检验分析;计数资料采用χ2检验或Fisher确切概率法分析,化疗毒副反应采用秩和检验,用Kaplan-Meier法进行生存曲线及单因素分析,多因素分析采用Cox比例风险回归模型,Log-rank检验生存差异,检验水平a=0.05,P0.05时差异有统计学意义。结果1.在74例III～IV期的卵巢上皮性癌患者中,35例试验组患者接受肿瘤细胞减灭术,术后给予腹腔热灌注联合静脉化疗,39例对照组患者接受肿瘤细胞减灭术联合静脉化疗,两组患者在年龄、病理类型、临床分期、残余病灶等方面,差异无统计学意(P0.05)。2.试验组与对照组治疗后CA125治疗有效率分别是91.43%,79.49%,两组对比差异有统计学意义(P0.05),腹水缓解率分别是97.14%,84.62%,差异有统计学意义(P0.05)。3.两组患者常见不良反应为骨髓抑制、肝肾功能损害、胃肠道反应、周围神经毒性、心血管损伤等方面,试验组骨髓抑制、胃肠道毒副反应加重。4.试验组患者总生存期明显延长,两组对比差异有统计学意义,试验组和对照组5年生存率分别为42.86%、33.33%。结论1.腹腔热灌注化疗联合静脉化疗的近期疗效明显,可有效控制腹水,提高临床缓解率,优于单纯静脉组。2.腹腔热灌注化疗联合静脉化疗胃肠道反应及骨髓抑制高于单纯静脉组,对症治疗后可缓解,未出现严重并发症,安全可行。3.腹腔热灌注化疗联合静脉化疗能够延长患者的中位总生存期,提高5年生存率。
[Abstract]:Background and objective ovarian cancer (OC) is one of the most common malignant tumors in the female reproductive system. Its incidence is second only to cervical cancer and endometrial cancer, but the mortality rate ranks first in gynecologic malignant tumors. Ovarian epithelial tumor is the most common ovarian tumor, accounting for 85% to 90% of ovarian malignant tumors, which is a serious threat to women's health. 2015 The NCCN guide points out that the standard treatment of advanced epithelial ovarian cancer is a satisfactory tumor cell reduction surgery (as far as possible all lesions visible to the naked eye, the residual cancer 1cm), comprehensive staging, sufficient chemotherapy, radiotherapy, and biological treatment after operation. Ovarian cancer has undergone extensive and diffuse implantation in the abdominal cavity, and there are still smaller residual foci and cancer cells after tumor cell subtraction. Although most ovarian cancer patients are relatively sensitive to platinum based chemotherapeutic drugs, it is difficult to achieve intraperitoneal drug concentration due to the presence of blood peritoneal barrier. The prognosis is poor and the recurrence rate is high. Intraperitoneal chemotherapy is to put chemotherapy drugs into the abdominal cavity directly, increase the contact area of the drug and malignant tumor, improve the local drug concentration and improve the curative effect. Peritoneal perfusion chemotherapy has played a very good effect in the treatment of gastrointestinal tumor. In recent years, the clinical application of intraperitoneal hyperthermia chemotherapy combined with intravenous chemotherapy has increased gradually in recent years. However, there is no unified standard about the perfusion and perfusion time. The clinical effect of intraperitoneal perfusion combined with intravenous chemotherapy after the operation of oval carcinoma is studied in this study. And further study of safety to provide more therapeutic methods for advanced ovarian cancer. Data and methods 1. sources: analysis of 74 cases of advanced epithelial ovarian cancer diagnosed in phase III to IV of the Second Affiliated Hospital of Zhengzhou University from 01 months to 06 months from 2011 to 06 months. 74 cases of advanced ovarian cancer were divided into two groups: Test Group 35 cases (intra-abdominal heat perfusion chemotherapy combined with intravenous chemotherapy), 39 cases in the control group (postoperative intravenous chemotherapy). Observe the short-term efficacy of the two treatments and the side effects of chemotherapy, and compare the survival of the two groups, to explore the clinical value of.2. in the clinical value of peritoneal perfusion chemotherapy in advanced epithelial ovarian cancer: the use of SPSS17. 0 software analysis, the measurement data were represented by mean number + standard deviation (? X + s), using t test analysis, the count data were analyzed by chi 2 test or Fisher exact probability method. The toxic and side effects of chemotherapy were tested by rank sum test, Kaplan-Meier method for survival curve and single factor analysis, multi factor analysis using Cox proportional risk regression model, Log-rank test student. The difference was statistically significant. Results 1. of the 74 cases of ovarian epithelial cancer in the III to IV stage, 35 of the 74 patients with III to IV were treated with tumor cell subtraction, postoperative intraperitoneal perfusion combined with intravenous chemotherapy, 39 cases of control group received tumor cell subtraction combined with intravenous chemotherapy, and the two group of patients were in the year. Age, pathological type, clinical stage and residual focus were not statistically significant (P0.05) in.2. test group and control group, the effective rate of CA125 treatment was 91.43%, 79.49%, and two groups were statistically significant (P0.05), and the remission rate of ascites was 97.14% and 84.62%, respectively. The difference was statistically significant (P0.05).3. two group patients common adverse reaction Bone marrow suppression, liver and kidney function damage, gastrointestinal reaction, peripheral neurotoxicity, cardiovascular damage, and other aspects, the total survival time of the test group was significantly prolonged in the.4. test group, the two groups were statistically significant, the 5 year survival rate of the experimental group and the control group was 42.86%, and the 33.33%. conclusion was 1. abdominal cavity. Hot perfusion chemotherapy combined with intravenous chemotherapy has obvious curative effect. It can effectively control ascites and improve clinical remission rate. It is superior to pure vein group.2. intraperitoneal hyperthermic chemotherapy combined with intravenous chemotherapy and gastrointestinal reaction and bone marrow suppression higher than that of pure vein group. It can be relieved after symptomatic treatment, without serious complications and safe and feasible.3. peritoneal perfusion. Chemotherapy combined with intravenous chemotherapy can prolong the median overall survival and increase the 5 year survival rate.
【学位授予单位】：郑州大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R737.31

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