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目的:对3种不同腹腔灌注联合静脉化疗方案进行疗效及安全性比较。方法:收集获得满意肿瘤细胞减灭术的99例Ⅲ/Ⅳ期上皮性卵巢癌患者的临床资料,根据化疗方案将入组病例分为3组。A组化疗方案为:紫杉醇175 mg·m~(-2)第1天静脉滴注(维持3 h)+顺铂75 mg·m~(-2)第1天腹腔灌注,3个疗程,然后紫杉醇175 mg·m~(-2)第1天静脉滴注(维持3 h)+卡铂AUC6第1天静脉滴注,3~5个疗程;B组化疗方案为:紫杉醇175 mg·m~(-2)第1天静脉滴注(维持3 h)+顺铂75 mg·m~(-2)第1天腹腔灌注,6~8个疗程;C组化疗方案为:紫杉醇175 mg·m~(-2)第1天静脉滴注(维持3 h)+顺铂75 mg·m~(-2)第2天腹腔灌注+紫杉醇60 mg·m~(-2)第8天腹腔灌注,6~8个疗程。比较化疗相关不良反应的发生率及各组病例无进展生存期(PFS)和5年总生存期(OS)。结果:A组病例的中位PFS为23个月,B组病例的中位PFS为29个月,C组病例的中位PFS为33个月,3组之间差异具有统计学意义(P=0.025)。A组病例的中位5年OS为48个月,B组病例的中位5年OS为51个月,C组病例的中位5年OS为51个月,3组之间差异无统计学意义(P=0.576)。3组的骨髓抑制发生率差异无统计学意义,而消化道反应、腹痛、化疗管相关并发症(堵塞、脱落)以及因此而导致的既定化疗方案中断或改变的发生率差异有统计学意义。结论:晚期上皮性卵巢癌的3种腹腔化疗方案中,B、C组优于A组,能明显延长PFS,但并不能延长5年OS,相反明显增多导管相关并发症、消化道反应、腹痛等不良反应。
Objective: To compare the efficacy and safety of three different intraperitoneal perfusion combined with intravenous chemotherapy. Methods: The clinical data of 99 patients with stage Ⅲ / Ⅳ epithelial ovarian cancer who were satisfied with tumor cytoreduction were collected. The patients were divided into 3 groups according to the chemotherapy regimen. The chemotherapy regimen in group A was as follows: paclitaxel 175 mg · m -2 on day 1, intravenous drip for 3 h and cisplatin 75 mg · m -2 on day 1 for three courses of treatment, then Paclitaxel 175 mg · m -2 day 1 intravenous drip (maintain 3 h) + carboplatin AUC6 day 1 intravenous drip, 3 to 5 courses; B chemotherapy regimen: paclitaxel 175 mg · m ~ (-2) intravenous drip (maintain 3 h) on day 1 + cisplatin 75 mg · m -2 on the 1st day after intraperitoneal perfusion, 6 to 8 courses of treatment; C chemotherapy regimen: paclitaxel 175 mg · m (-2) on the first day of intravenous infusion (maintenance of 3 h) + cisplatin 75 mg · m -2 day 2 intraperitoneal perfusion + paclitaxel 60 mg · m -2 on the 8th day of intraperitoneal perfusion, 6 to 8 courses. The incidence of chemotherapy-related adverse reactions was compared between the two groups in terms of progression-free survival (PFS) and 5-year overall survival (OS). Results: The median PFS in group A was 23 months. The median PFS in group B was 29 months. The median PFS in group C was 33 months. The difference between the 3 groups was statistically significant (P = 0.025). The median 5-year OS in group A was 48 months, the median 5-year OS in group B was 51 months, and the median 5-year OS in group C was 51 months. There was no significant difference between the 3 groups Significance (P = 0.576). There was no significant difference in the incidence of myelosuppression among the three groups, but there was statistically significant difference in incidence of digestive tract reaction, abdominal pain, chemotherapy tube related complications (occlusion, exfoliation) and the resulting discontinuation or alteration of the established chemotherapy regimen. CONCLUSIONS: In the three kinds of intraperitoneal chemotherapy regimens of advanced epithelial ovarian cancer, B and C groups are superior to A group, PFS can be prolonged obviously, but they can not extend OS for 5 years. On the contrary, they obviously increase the incidence of catheter-related complications, gastrointestinal reaction, abdominal pain Other adverse reactions.