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目的 探讨晚期卵巢上皮性癌化学药物治疗 (化疗 )的意义及远期疗效的影响因素。方法 自 1986年 1月至 1997年 12月我院收治晚期卵巢上皮性癌患者 348例 ,根据残留癌直径的大小分为切净组 (残留癌直径≤ 1cm)和未切净组 (残留癌直径 >1cm) ,Log rank检验分析两组患者的生存率差异 ,Logistic回归模型分析影响远期疗效 (实际 5年生存时间 )的因素。结果 切净组患者术后有、无腹腔化疗的中位生存期分别为 4 6个月和 36个月 ,差异有显著性 (χ2 =7 39,P =0 0 0 6 5 ) ;未切净组患者术后静脉化疗 >6个疗程与≤ 6个疗程的中位生存期分别是 2 2个月和 11个月 ,差异有显著性 (χ2=4 31,P =0 0 380 )。多因素分析结果显示 ,切净组患者的预后与术后腹腔化疗有关 ;而未切净组患者的预后则与术后静脉化疗、术前化疗 (P <0 0 1)和病理分级 (P <0 0 5 )有关。晚期卵巢上皮性癌患者的远期疗效主要与残留癌直径 (P <0 0 1)、术后腹腔化疗 (P <0 0 5 )、病理分级 (P <0 0 5 )有关。结论 术后给予 >6个疗程的静脉化疗改善了晚期卵巢上皮性癌未切净组患者的近期疗效 ,但远期疗效无明显改善。腹腔化疗与晚期卵巢上皮性癌患者的远期疗效有关 ,提高了切净组患者的生存期
Objective To investigate the significance of the chemotherapeutic drugs for advanced epithelial ovarian cancer and the influencing factors of long-term efficacy. Methods From January 1986 to December 1997, 348 patients with advanced epithelial ovarian cancer were treated in our hospital. According to the diameter of residual cancer, the patients were divided into two groups: residual group (≤1cm in residual cancer) and uncut group > 1cm). Log rank test was used to analyze the difference of survival rate between the two groups. Logistic regression model was used to analyze the factors influencing long-term efficacy (actual 5-year survival time). Results The median survival time of the patients in the subcutaneous neoadjuvant group after surgery was 46 months and 36 months respectively, with significant difference (χ2 = 7 39, P = 0 0 055); The median survival time of patients after 6 months and 6 cycles of intravenous chemotherapy was 22 and 11 months, respectively, with significant difference (χ2 = 4 31, P = 0 0 380). The results of multivariate analysis showed that the prognosis of patients in the subcutaneous group was related to postoperative intraperitoneal chemotherapy. However, the prognosis of patients in the subcutaneous group was not significantly different from postoperative chemotherapy, preoperative chemotherapy (P <0.01) and pathological grade (P < 0 0 5) related. The long-term efficacy of advanced ovarian cancer is mainly associated with residual cancer diameter (P <0.01), postoperative intraperitoneal chemotherapy (P <0.05) and pathological grade (P <0 05). Conclusions Intravenous chemotherapy with> 6 courses of postoperative treatment can improve the short-term curative effect of patients with advanced ovarian epithelial carcinoma without cleavage. However, there is no obvious improvement in long-term curative effect. Intraperitoneal chemotherapy is associated with long-term efficacy in patients with advanced epithelial ovarian cancer, increasing the survival of patients in the cut-net group