摘要目的 探讨晚期(Ⅲ～Ⅳ期)卵巢上皮性癌(卵巢癌)患者初次治疗过程中血清CA125水平变化与其预后的关系.方法 选择1998年1月-2003年12月间中山大学肿瘤防治中心妇瘤科收治的142例晚期卵巢癌患者,回顾性分析其初次治疗过程中血清CA125水平的变化,采用Kaplan-Meier法计算其累积生存率,并采用Cox风险比例回归模型分析血清CA125水平的变化对患者预后的影响.结果 根据患者治疗前血清CA125水平不同分为≤500、>500～1500和>1500 kU/L,其3年累积生存率(分别为64%、71%及64%)比较,差异无统计学意义(P>0.05).术后接受3个疗程化疗后,血清CA125水平降至正常(0～35 kU/L)的77例患者的3年及5年累积生存率分别为84%及56%,明显高于血清CA125水平仍为异常的48例患者(分别为42%、15%,P<0.01).多因素分析表明,残留灶直径(P<0.01)及3个疗程化疗后血清CA125水平(P<0.01)是影响晚期卵巢癌患者预后的独立的因素.进一步分层分析表明,接受了满意的肿瘤细胞减灭术(残留灶直径≤1 cm)的患者中,3个疗程化疗后血清CA125水平降至正常者的3年及5年累积生存率分别为88%、64%,明显高于化疗后血清CA125笛水平仍为异常者(分别为52%、18%,P<0.01);同样,接受了不满意的肿瘤细胞减灭术(残留灶直径>1 cm)的患者中,3个疗程化疗后血清CA125水平降至正常者的3年和5年累积生存率分别为74%、32%,明显高于化疗后血清CA125水平仍为异常者的33%、13%(P<0.01).结论 3个疗程化疗后血清CA125水平正常与否可预测晚期卵巢癌患者的预后,且无论初次手术是否为满意的肿瘤细胞减灭术,3个疗程化疗后血清CA125水平降至正常者较未降至正常者预后好.

abstractsObjective To investigate the prognostic value of the changes in serum CA125 level during chemotherapy post-surgery in patients with advaneed epithelial ovarian carcinoma.Methods A retrospective analysis was conducted on 142 patients with stage Ⅲ-Ⅳ epithelial ovarian carcinoma who had primary treatment in the Cancer Center of the Sun Yat-sen University during January 1998 to December 2003.The changes in CA125 levels during chemotherapy post-surgery in patients were analyzed.The survival outcomes of patients with various levels of CA125 were studied using Kaplan-Meier method.Multivariate Cox regression model Wag used to aggess the correlations between survival and the change in CA125 level during chemotherapy and other prognostic factors.Results The 3-year overall survival(OS)was 64%,71%,and 64%respectively in patients with different pretreatment CA125 levels(≤500,>500-1500 and>1500 kU/L;P>0.05).The CA125 level was normalized(0-35 kU/L)in 77(54.2%)patients after three cycles of postoperative chemotherapy.It revealed significant differences in 3-year OS(84%vs.42%)and 5-year OS(56%vs.15%)between the patients with normalized and elevated CA125 levels(n=48)after three cycles of chemothempy(P<0.01).Multivariate analysis showed that residual tumor size>1 cm(P<0.01)and elevated CA125 after three-cycle postoperative chemotherapies(P<0.01)were two independent factors related to survival.In the subgroup of optimal cytoreduction(residual tumor size≤1 cm),the 3-year and 5-year OS rate were 88%and 64%for patients with normalized CA125 level after three cycles of chemotherapy respectively,while only 52%and 18%for patients with elevated CA125 level(P<0.01).Similarly,even in the suboptimal cytoreduction group,the 3-year and 5-year OS were also significantly increased for patients with normalized CA125 level after three cycles of chemotherapy post-surgery,as compared with patients with elevated CA125 level(74%vs.33%in 3-year OS,32%vs.13%in 5-year OS;P<0.01).Conclusions CA125 level after three cycles of chemotherapy post-surgery is an independent predictor of survival for advanced ovarian carcinoma.Whatever the patients undergo,optimal or suboptimal cytoreduction,ifthe CA125 becomes normalized after three cycles of chemotherapy,they would have more favorable prognosis than those with elevated CA125 after three cycles of chemotherapy.