Tkácová M, Belohorská B, Sevcíková K, Hel'pianska L, Ondrus D, Ondrusová M, Spánik S
I. Onkologická klinika LF UK a OUSA, Heydukova 10, 812 50 Bratislava, Slovenská republika.
Klin Onkol. 2010;23(2):115-23.
Treatment of recurrent ovarian cancer is not standardized. Pre-clinical tests have confirmed the synergistic effect of gemcitabine and platinum, which can break through drug resistance to platinum. Therefore, efficacy of a combined gemcitabine and platinum-based regimen can be expected not only in therapy platinum-sensitive but also in platinum-resistant disease. Surgery--so-called secondary (eventually tertiary) cytoreductive surgery, should be considered in recurrent disease before planning the chemotherapy.
This is a retrospective analysis of 58 patients with recurrent ovarian cancer treated with a gemcitabine and platinum-based regimen (GP) as the second or third-line chemotherapy. Some of the patients underwent secondary cytoreductive surgery before starting the systemic treatment. The aim of the study was to detect the response rate, progression-free survival and overall survival in the whole group of patients and in subgroups with platinum-sensitive and platinum-resistant disease. Another aim was to detect the correlation between secondary cytoreductive surgery and the efficacy of chemotherapy.
Systemic treatment (GP) has helped to achieve a response rate of 53.5%, with time to progression 10 months and overall survival 23.5 months. A better response rate, progression free survival and overall survival were achieved in the group of patients with platinum-sensitive disease compared to patients with platinum-resistant disease, but this difference was not statistically significant. 20 patients underwent effective secondary cytoreductive surgery before the systemic treatment. Patients who underwent effective secondary cytoreductive surgery had a statistically better response rate (RR: 80% vs 39.5%), longer progression-free survival (PFS: 13.5 m vs 9 m, p = 0.006) and longer overall survival (OS: 40 m vs 16.9 m, p = 0.006) when compared to patients without secondary cytoreductive surgery.
We have confirmed the efficacy of a gemcitabine and platinum-based regimen in the therapy of recurrent ovarian cancer, in both platinum-sensitive and platinum-resistant disease. An important prognostic factor in the whole group of patients was the realization of effective secondary cytoreductive surgery.
复发性卵巢癌的治疗尚无标准化方案。临床前试验已证实吉西他滨与铂类药物具有协同作用，可突破对铂类药物的耐药性。因此，预计吉西他滨与铂类联合方案不仅对铂敏感型疾病有效，对铂耐药型疾病也有效。在计划化疗前，对于复发性疾病应考虑进行手术——即所谓的二次（最终为三次）减瘤手术。
这是一项对58例接受吉西他滨与铂类联合方案（GP）作为二线或三线化疗的复发性卵巢癌患者的回顾性分析。部分患者在开始全身治疗前接受了二次减瘤手术。本研究的目的是检测整个患者群体以及铂敏感型和铂耐药型疾病亚组的缓解率、无进展生存期和总生存期。另一个目的是检测二次减瘤手术与化疗疗效之间的相关性。
全身治疗（GP）使缓解率达到53.5%，疾病进展时间为10个月，总生存期为23.5个月。与铂耐药型患者相比，铂敏感型患者组的缓解率、无进展生存期和总生存期更好，但这种差异无统计学意义。20例患者在全身治疗前接受了有效的二次减瘤手术。与未接受二次减瘤手术的患者相比，接受有效二次减瘤手术的患者缓解率在统计学上更高（RR：80%对39.5%），无进展生存期更长（PFS：13.5个月对9个月，p = 0.006），总生存期更长（OS：40个月对16.9个月，p = 0.006）。
我们证实了吉西他滨与铂类联合方案在复发性卵巢癌治疗中的疗效，无论是铂敏感型还是铂耐药型疾病。在整个患者群体中，一个重要预后因素是实施有效的二次减瘤手术。
