Brun J L, Feyler A, Chêne G, Saurel J, Brun G, Hocké C
Department of Obstetrics and Gynecology, Centre Hospitalier Universitaire de Bordeaux, France.
Gynecol Oncol. 2000 Jul;78(1):21-7. doi: 10.1006/gyno.2000.5805.
The aim of this study was to evaluate long-term results and to assess prognostic factors which have an impact on overall survival in patients with epithelial ovarian cancer.
A retrospective analysis of 287 patients treated between 1975 and 1995 was performed. All operations were performed by senior surgeons. Histologic sections were reviewed by the same pathologist. Successive adjuvant chemotherapy regimens are described. Survival was evaluated in 1997. Follow-up lasted 25-260 months (median 90). Statistical methods included Kaplan-Meier survival curves, log-rank test, and multivariate analysis.
The 5-year survival rates were 76, 42, 21, and 6% for patients with stage I, II, III, and IV disease, respectively. Age, FIGO stage, cytology of ascites, histologic type and grade, extent of surgery, and number of residual tumors were significant prognostic indicators in univariate analysis. Multivariate analysis showed that the risk of mortality according to FIGO stage was 2.8, 95% CI [1.2-6.3], P = 0.01 for FIGO II, 5.6, 95% CI [2.9-10.8], P < 0.001 for FIGO III, and 10.5, 95% CI [4.9-22. 1], P < 0.001 for FIGO IV in comparison with FIGO I. Patients with a serous epithelial carcinoma had a 1.7-fold higher risk of mortality than patients with other histologic types: RR = 1.7, 95% CI [1.1-2. 8], P < 0.001. Patients whose tumors distribution permitted optimal surgery had a 2.3-fold lower risk of mortality than patients treated with sub- or nonoptimal surgery: RR = 0.43, 95% CI [0.29-0.64], P < 0.001. The risk of mortality for patients treated with alkylating agents, platinum-based combination chemotherapy without taxanes, or carboplatin plus paclitaxel regimens compared with patients who did not receive treatment was reduced by 47%, 95% CI [8-69%], P = 0.025, 55%, 95% CI [22-74%], P = 0.005, and 70%, 95% CI [35-86%], P = 0.002, respectively.
Our study confirms the benefit of cytoreductive surgery and the efficacy of platinum plus paclitaxel first-line chemotherapy which has recently been recognized as the standard treatment for advanced epithelial ovarian cancer.
本研究旨在评估上皮性卵巢癌患者的长期治疗结果，并评估影响总生存期的预后因素。
对1975年至1995年间接受治疗的287例患者进行回顾性分析。所有手术均由资深外科医生实施。组织学切片由同一位病理学家复查。描述了后续的辅助化疗方案。1997年对生存期进行评估。随访持续25 - 260个月（中位时间90个月）。统计方法包括Kaplan-Meier生存曲线、对数秩检验和多变量分析。
Ⅰ、Ⅱ、Ⅲ和Ⅳ期疾病患者的5年生存率分别为76%、42%、21%和6%。年龄、国际妇产科联盟（FIGO）分期、腹水细胞学检查、组织学类型和分级、手术范围以及残留肿瘤数量在单变量分析中是显著的预后指标。多变量分析显示，与FIGOⅠ期相比，FIGOⅡ期患者的死亡风险为2.8，95%置信区间[1.2 - 6.3]，P = 0.01；FIGOⅢ期患者的死亡风险为5.6，95%置信区间[2.9 - 10.8]，P < 0.001；FIGOⅣ期患者的死亡风险为10.5，95%置信区间[4.9 - 22.1]，P < 0.001。浆液性上皮癌患者的死亡风险比其他组织学类型的患者高1.7倍：风险比（RR）= 1.7，95%置信区间[1.1 - 2.8]，P < 0.001。肿瘤分布允许进行最佳手术的患者的死亡风险比接受次优或非最佳手术的患者低2.3倍：RR = 0.43，95%置信区间[0.29 - 0.64]，P < 0.001。与未接受治疗的患者相比，接受烷化剂、不含紫杉烷的铂类联合化疗或卡铂加紫杉醇方案治疗的患者的死亡风险分别降低了47%，95%置信区间[8 - 69%]，P = 0.025；55%，95%置信区间[22 - 74%]，P = 0.005；70%，95%置信区间[35 - 86%]，P = 0.002。
我们的研究证实了肿瘤细胞减灭术的益处以及铂类加紫杉醇一线化疗的疗效，该化疗方案最近已被公认为晚期上皮性卵巢癌的标准治疗方法。
