中国实用妇科与产科杂志

中国实用妇科与产科杂志

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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

杜雪莲，王聪，刘明，郑兴，卢乡伟，盛修贵   

  1. 作者单位：山东省肿瘤医院，山东 济南 250117
  • 出版日期:2015-01-02 发布日期:2015-01-05
  • 通讯作者: 盛修贵
  • 基金资助:

    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）

Clinical study of sequential chemotherapy with paclitaxel plus carboplatin and gemcitabine based medication in reducing recurrence of epithelial ovarian cancer.

DU Xue-lian,WANG Cong,LIU Ming,ZHENG Xing,LU Xiang-wei,SHENG Xiu-gui.   

  1. Department of Gynecologic Oncology, Shandong Cancer Hospital, Jinan 250117, China
  • Online:2015-01-02 Published:2015-01-05

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（P>0.05）。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（P>0.05）。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(P>0.05)；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。

关键词: 卵巢肿瘤, 紫杉醇, 吉西他滨, 序贯化疗

Abstract:

Abstract： Objective To study the clinical value of sequential chemotherapy by using paclitaxel plus carboplatin and gemcitabine based medication in preventing drug resistance of epithelial ovarian cancer.Methods Totally 121 patients with operation pathological stageⅢc epithelial ovarian cancer between April 2005 and June 2011 at the Department of Gynecologic Oncology, Shandong Cancer Hospital were analyzed. Two to four cycles of gemcitabine based combination chemotherapy were performed after 4 cycles of paclitaxel-carboplatin in 59 patients (sequential chemotherapy group). Routinely 6 to 8 cycles of paclitaxel-carboplatin were performed in other 62 patients (TC group). Treatment response, recurrence, toxicities, progress-free survival (PFS) and overall survival (OS) were assessed. Results The median follow-up time was 39 mon (4 to 73 mon) and 41 mon (3 to 69 mon), respectively. Similar treatment response and recurrence were found between two groups (P>0.05). Significantly higher PFS was found in sequential chemotherapy group than in TC group (28 vs. 18 mon, P=0.037). Improved 1- and 3-year PFS was observed in sequential chemotherapy group (1-yr: 87.5% vs. 72.4%; 3-yr:35.7% vs.24.1%, P<0.05). Moreover, obviously higher 5-yr OS was found in sequential chemotherapy group (32.2% vs. 18.6%). Three to four levels of nervous system toxicity was significantly lower in sequential chemotherapy group than that in conventional group (3.3% vs. 14.5%，P=0.016).Conclusion Sequential chemotherapy method using 2 to 4 cycles of gemcitabine based combination chemotherapy after 4 cycles of paclitaxel-carboplatin can delay recurrence and obviously improve the 1- and 3 -yr PFS and 5-yr OS with lower nervous system toxicity.

Key words: ovarian cancer, paclitaxel, gemcitabine, sequential chemotherapy

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