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目的探讨可以预测铂类联合紫杉醇作为晚期卵巢癌术后一线化疗疗效的预测因素和预测分子。方法回顾42例以铂类联合紫杉醇作为一线化疗的晚期卵巢上皮癌临床病理学资料,用免疫组织化学方法检测卵巢癌组织中的 p53和 Pgp 表达,计算一线化疗临床完全缓解率和早期复发率。分析年龄、残留病灶大小、病理学类型、分化程度、p53及 Pgp 表达等指标作为化疗疗效预测因素或预测因子的可行性。结果 24例(57%)患者临床完全缓解,7例(17%)早期复发。单因素分析提示 p53阳性患者完全缓解率(74%)有高于 p53阴性患者(完全缓解率43%)的趋势;残留病灶<2cm 者早期复发率(4.2%)低于残留病灶≥2 cm 者(33%)。多因素分析提示残留病灶≥2 cm 和 Pgp阳性是早期复发的独立预后因素。结论残留病灶大小、p53表达、Pgp 表达可以作为铂类联合紫杉醇化疗疗效的预测因素,p53阳性者对化疗相对敏感,残留病灶≥2 cm、Pgp 阳性者对化疗相对耐药。
Objective To investigate the predictive and predictive factors that can predict the efficacy of platinum combined with paclitaxel in the treatment of advanced ovarian cancer after first-line chemotherapy. Methods The clinical data of 42 patients with advanced epithelial ovarian cancer treated with platinum and paclitaxel as first-line chemotherapy were retrospectively analyzed. The expression of p53 and Pgp in ovarian cancer tissues was detected by immunohistochemical method and the clinical complete response rate and early recurrence rate were calculated. Analysis of age, residual lesion size, pathological type, degree of differentiation, p53 and Pgp expression as predictors of chemotherapy efficacy or predictors of feasibility. Results Twenty-four patients (57%) achieved complete clinical remission and 7 patients (17%) had early recurrence. Univariate analysis showed that the complete remission rate (74%) in p53-positive patients was higher than that in p53-negative patients (complete remission rate was 43%); the early recurrence rate (4.2%) was lower in residual lesions <2cm than that in residual lesions> 2cm (33%). Multivariate analysis suggested that the residual tumor≥2 cm and Pgp positivity were the independent prognostic factors of early recurrence. Conclusions The size of residual lesion, p53 expression and Pgp expression can be used as predictive factors for the efficacy of platinum combined with paclitaxel chemotherapy. P53 positive patients are relatively sensitive to chemotherapy with residual lesions ≥ 2 cm. Pgp positive patients are relatively resistant to chemotherapy.