Sun T, Feng Y
Department of Obstetrics and Gynecology, Shanghai First People's Hospital, China.
Chin Med J (Engl). 1998 Mar;111(3):272-4.
To evaluate the effectiveness of second cytoreductive surgery in the treatment of epithelial ovarian cancer.
From January 1989 to June 1994, second cytoreductive surgery was carried out on 33 patients with epithelial ovarian cancer who either underwent unsatisfactory primary debulking operation or had recurrence. According to FIGO staging (1987), there were 5 patients in stage I, 2 in stage II, 25 in stage III, and 1 in stage IV. Pathological grading was G1 in 2 cases, G2 in 9, G3 in 19 and uncertain in 3. The 33 patients can be divided into 3 categories: I, nine patients who had unsatisfactory primary debulking operation with macroscopic residual > 2 cm, and 1-2 courses of postoperative chemotherapy; II, 15 patients who had 6-8 courses of cisplatin-based postoperative chemotherapy and in whom recurrence was diagnosed after complete response for at least 3 months; and III, 9 patients who had the same treatment as category II and survived without cancer clinically for more than 6 months, and in whom recurrence was diagnosed during second-look laparotomy. All patients had been followed up for at least two years (27-168 months) dated from the primary debulking operation.
Fifteen cases had no macroscopic residuals (group A), 5 had residuals < 2 cm (group B), and 13 had residuals > 2 cm (group C). The medium survival time and two-year survival rate in groups A, B and C were 59.09, 20.6 and 8.29 months, and 93.3%, 20% and 7.69% respectively (P < 0.001, A vs C; P < 0.05, A vs B and B vs C).
The results suggest that second cytoreductive surgery is of value, and the key to success is to eliminate any macroscopic residual focus, or at most, to leave only minimal residuals < 2 cm. It is suggested that well-targeted multiple-route chemotherapy with sufficient courses before second cytoreductive surgery is important to achieving better results.
评估二次肿瘤细胞减灭术治疗上皮性卵巢癌的疗效。
1989年1月至1994年6月，对33例上皮性卵巢癌患者实施二次肿瘤细胞减灭术，这些患者要么初次肿瘤细胞减灭术未达满意效果，要么出现复发。根据国际妇产科联盟（FIGO，1987年）分期，Ⅰ期5例，Ⅱ期2例，Ⅲ期25例，Ⅳ期1例。病理分级为G1级2例，G2级9例，G3级19例，3例分级不明。33例患者可分为3类：Ⅰ类，9例初次肿瘤细胞减灭术未达满意效果，肉眼残留＞2 cm，术后接受1 - 2个疗程化疗；Ⅱ类，15例术后接受6 - 8个疗程以顺铂为基础的化疗，在至少3个月完全缓解后诊断为复发；Ⅲ类，9例接受与Ⅱ类相同的治疗，临床无癌生存超过6个月，在二次剖腹探查术中诊断为复发。所有患者自初次肿瘤细胞减灭术起均至少随访两年（27 - 168个月）。
15例无肉眼残留（A组），5例残留＜2 cm（B组），13例残留＞2 cm（C组）。A、B、C三组的中位生存时间及两年生存率分别为59.09、20.6和8.29个月，以及93.3%、20%和7.69%（A组与C组比较，P＜0.001；A组与B组比较及B组与C组比较，P＜0.05）。
结果表明二次肿瘤细胞减灭术有价值，成功的关键在于消除任何肉眼可见的残留病灶，或至多仅留下＜2 cm的微小残留。建议在二次肿瘤细胞减灭术前进行有针对性的多途径充分疗程化疗，这对于取得更好的疗效很重要。
