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目的 通过分析初次不满意肿瘤细胞减灭术的卵巢上皮性癌(卵巢癌)患者术后辅以化疗后血清CA125水平变化,探讨其对间歇性肿瘤细胞减灭术满意度及对卵巢癌患者复发和预后预测的意义.方法 选择1996年1月至2009年1月间因初次不满意肿瘤细胞减灭术,术后行以铂类药物为主的联合化疗2～5个疗程,再行间歇性肿瘤细胞减灭术的晚期(Ⅲ期33例、Ⅳ期6例)卵巢癌患者39例.患者年龄41 ～68岁,平均56岁；病理类型:浆液性癌32例,非浆液性癌7例.按患者初次手术后及术后辅助化疗后血清CA125水平不同分为4组,A组:为初次手术后血清CA125水平即降至正常(正常水平＜ 35 kU/L)者,共6例；B组:为初次手术后1～2个疗程化疗后血清CA125水平降至正常者,共11例；C组:为初次手术后3～4个疗程化疗后血清CA125水平降至正常者,共14例；D组:为初次手术后2～5个疗程化疗后血清CA125水平仍未降至正常者,共8例.分析4组患者间歇性肿瘤细胞减灭术的满意度、术后残留灶病理、复发及预后情况.结果 (1)间歇性肿瘤细胞减灭术的满意度:获满意的间歇性肿瘤细胞减灭术者,A、B、C、D组患者分别占6/6、8/11、9/14、2/8,A、B组分别与D组比较,差异均有统计学意义(P＜0.05).(2)术后残留灶病理检查结果:间歇性肿瘤细胞减灭术后残留灶镜下检查,A、B、C、D组患者病理阴性者分别占4/6、4/11、5/14及0,A组与D组比较,差异有统计学意义(P=0.030).(3)复发:间歇性肿瘤细胞减灭术后,A、B、C、D组患者复发率分别为3/6、9/11、12/14、8/8,A组与D组比较,差异有统计学意义(P=0.024)；B、C组的复发率较D组虽有降低趋势,但差异无统计学意义(P＞0.05).A、B、C、D组患者铂类耐药型复发率分别为1/6、3/11、5/14、7/8,A、B、C组分别与D组比较,差异均有统计学意义(P＜0.05).(4)预后:A、B、C、D组患者的中位无进展生存时间分别为32、10、18和3个月.A、B、C组分别与D组比较,差异均有统计学意义(P＜0.05).A、B、C、D组患者的中位总生存时间分别为44、45、44和16个月,A、B及C组分别与D组比较,差异均有统计学意义(P＜0.05).结论 初次不满意的肿瘤细胞减灭术后接受以铂类药物为主的联合化疗后血清CA125水平迅速降至正常的卵巢癌患者,更易达到满意的间歇性肿瘤细胞减灭术,并对其复发类型和预后有一定的预测作用.

Objective To investigate the changes of CA125 between primary cytoreductive surgery and interval debulking surgery for prediction the rate of optimal interval cytoreductive surgery and prediction the recurrence and the prognosis in patients with epithelial ovarian cancer.Methods A total of 39 cases with suboptimal primary cytoreductive surgery admitted from Jan.1996 to Jan.2009 were retrospectively analyzed.The median age of patients was 56 years( range:41 -68 years).Based on the changes in CA125level between primary cytoreductive surgery and interval debulking surgery,all cases were divided into four groups,group A (CA125 reduced to normal after primary cytoreductive surgery,n=6),group B (CA125reduced to normal after 1 - 2 cycles of chemotherapy,n =11 ),group C ( CA125 reduced to normal after 3 -4 cycles of chemotherapy,n =14),and group D ( CA125 did not reduced to normal after the chemotherapy,n =8 ), and all received platinum-based chemotherapy.The response to chemotherapy evaluated by pathological examination versus CA125 level,and recurrence and prognoses were also analyzed.Results ( 1 )The rate of optimal interval cytoreductive surgery in group A,B,C and D were 6/6,8/11,9/14 and 2/8respectively,in which there were statistically different between group A or B and group D (P ＜0.05).(2)The clinical benefit rates evaluated by the pathological examination in group A,B,C and D were 4/6,4/11,5/14 and 0,respectively and there were statistically different between group A and group D (P =0.030).( 3 ) There was significant difference in the recurrence rate between group A and group D (3/6 vs.8/8,P =0.024),while there were not significant differences between group B or C and group D ( all P ＞ 0.05 ).The rate of drug-resistant recurrence in group A,B,C and D were 1/6,3/11,5/14 and 7/8,respectively,in which there were significant differences between group A,B or C and group D ( all P ＜ 0.05 ). ( 4 ) The median progression-free survival (PFS) for patients in group A,B,C and D were 32,10,18 and 3 months,respectively,in which there were significant differences in the PFS between group A,B or C and group D (P =0.012,P =0.003,P =0.032 ).The median overall survival (OS) were 44,45,44 and 16 months,respectively.There were significant differences in the OS between group A,B or C and group D ( P =0.022,P =0.004,P =0.000 ).Conclusion The change of CA125 between primary cytoreductive surgery and interval debulking surgery may be predict the recurrence type and the prognosis in patients with epithelial ovarian cancer.