58例晚期卵巢癌患者发生腹腔内转移后的临床特征、疗效及预后影响因素分析

doi:10.11904/j.issn.1002-3070.2016.04.007

摘要/Abstract

摘要： 目的探讨晚期卵巢癌患者发生腹腔转移后的临床特点、疗效,并探讨预后的影响因素。方法回顾性分析湖北省天门市第一人民医院肿瘤科3个病区2013年1月—2016年1月期间病理诊断明确、初诊且临床资料齐全的65例晚期卵巢癌患者,其中发生腹腔转移的58例,对58例患者预后影响因素进行单因素和多因素生存分析。结果 58例诊断卵巢癌腹腔转移患者的平均年龄为(49.2±6.5)岁,从确诊卵巢癌到发生腹腔转移的平均时间为11个月,卵巢癌腹腔转移患者的中位生存时间为8周,而7例未发生腹腔转移者的中位生存时间为15周。单因素生存曲线比较显示,患者婚姻状况、生育史、哺乳史、恶性腹水、新辅助化疗、综合治疗(化疗+开腹的肿瘤细胞减灭术+腹腔热灌注化疗)、腹腔转移瘤数目、残余病灶大小、患者的生存质量(卡氏评分)、血浆中D-二聚体水平、尿液中微量白蛋白的水平与患者的预后均有关(P＜0.05)。Cox多因素回归模型分析显示,患者生育史、综合治疗、血浆中D-二聚体的水平、尿液中微量白蛋白水平为影响患者预后的独立危险因素(P＜0.05)。结论晚期卵巢癌腹腔转移患者生存时间短,预后差;新辅助化疗联合肿瘤细胞减灭术及术后腹腔热灌注化疗,短期疗效好,既能提高晚期卵巢癌治疗有效性,又可改善晚期患者的生存质量;治疗前血浆中D-二聚体水平以及尿液中微量白蛋白持续维持在高水平或者不降低的患者,治疗效果差,预后也差,提示二者可以作为一种新的判断预后的指标。

关键词: 卵巢癌, 腹腔转移, 预后

Abstract: Objective To explore the clinical characteristics and the influence factors of prognosis of advanced ovarian cancer patients after abdominal metastases.Methods We retrospectively analyzed 65 cases during January 2013 to January 2016 in the First People′s Hospital of Tianmen.The patients were diagnosed clearly with pathological,diagnosed for the first time and has the complete clinical data including peritoneal metastases in 58 cases,which were analyzed for single factor and multiple factors of influencing factors survival analysis.Results 58 cases of patients with diagnosis of peritoneal metastasis in ovarian cancer that the average is(49.2±6.5),from ovarian cancer diagnosis to abdominal metastases for an average time of 11 months,ovarian cancer patients with peritoneal metastasis of the median survival time was 8 weeks,but 7 cases without abdominal metastases that the median survival time was 15 weeks.The single factor survival curves(Kaplan-meier)showed that marital status,reproductive history,history of breastfeeding,malignant ascites,neoadjuvant chemotherapy,comprehensive treatment(chemotherapy and tumor cells to destroy the loss and laparotomy abdominal hot perfusion chemotherapy),peritoneal metastasis tumor number,residual lesion size,quality of life in patients with residual lesions(KPS scores),D-dimer level in plasma and urine trace albumin levels related to the prognosis of patients(P＜0.05).Conclusion Patients with advanced ovarian cancer patients with peritoneal metastasis survival time is shorter,and also company with poor prognosis;Neoadjuvant chemotherapy combined tumor cells to destroy the loss and postoperative intraperitoneal hot perfusion chemotherapy,short-term curative effect is good,it can not only improve the advanced ovarian cancer treatment effectiveness,but also improve the quality of life in patients of late phase.The D-dimer level in plasma and urine trace albumin levels before treatment have remained in the patients with high level or not reduce,treatment effect and prognosis was poor.These can be used as a new index of judging prognosis.

Key words: Ovarian cancer, Abdominal cavity metastasis, Prognosis

中图分类号:

R737.31

余东阳,刘梓良,韩丽蓉. 58例晚期卵巢癌患者发生腹腔内转移后的临床特征、疗效及预后影响因素分析[J]. 实用肿瘤学杂志, 2016, 30(4): 321-326.

YU Dongyang,LIU Ziliang,HAN Lirong. The clinical features,curative effect and prognosis factors analysis in 58 patients with advanced ovarian cancer after intraperitoneal metastases[J]. PRACTICAL ONCOLOGY JOURNAL, 2016, 30(4): 321-326.

参考文献

1 Jemal A,Siegel R,Xu J,et al.Cancer statistics,2010[J].CA Cancer J Clin,2010,60(5):277-300.
2 柴婷婷.卵巢上皮性癌ⅢC期患者三种手术方式的临床分析比较[D].广东:广东医学院,2015.
3 杨蒋颖,程爱花,柴芝红.新辅助化疗联合肿瘤细胞减灭术及术后腹腔热灌注化疗对卵巢癌的疗效及生存质量的影响[J].中国医师杂志,2016,18(2):228-231.
4 于歌.卵巢癌DNA甲基化的研究进展[J].实用肿瘤学杂志,2013,27(1):81-84.
5 Feigenberg T,Clarke B,Virtanen C,et al.Molecular profiling and clinical outcome of high-grade serous ovarian cancer presenting with low-versus high-volume ascites[J].Biomed Res Int,2014,2014:367103.
6 林仲秋.FIGO/IGCS妇科恶性肿瘤分期及临床实践指南(六):卵巢癌[J].国际妇产科学杂志,2008,35(6):459-461.
7 刘萍,郭志,刘文欣,等.术前血浆D-二聚体水平与浆液性卵巢癌一线化疗疗效及预后的相关性评价[J].中国肿瘤临床,2015,42(18):916-920.
8 张颖,张英丽,张平.晚期卵巢癌新辅助化疗的研究进展[J].肿瘤学杂志,2014,20(11):942-946.
9 Beer JH,Haeberli A,Vogt A,et al.Coagulation markers predict survival in cancer patients[J].Thromb Haemost,2002,88(5):745-749.
10 Diao D,Wang Z,Cheng Y,et al.D-dimer:not just an indicator of venous thrombosis but a predictor of asymptomatic hematogenousmetastasis in gastric cancer patients[J].PLoS One,2014:9(7):e101125.
11 Diao D,Zhu K,Wang Z,et al.Prognostic value of the D-dimer test in oesophageal cancer during the perioperative period[J].J Surg Oncol,2013,108(1):34-41.
12 Mego M,Karaba M,Minarik G,et al.Relationship between circulating tumor cells,blood coagulation,and urokinase-plasminogen-activatorsystem in early breast cancer patients[J].Breast J,2015,21(2):155-160.
13 Palumbo JS,Talmage KE,Massari JV,et al.Tumor cell-associated tissue factor and circulating hemostatic factors cooperate to increase metastaticpotential through natural killer cell-dependent and-independent mechanisms[J].Blood,2007,110(1):133-141.
14 Palumbo JS,Talmage KE,Massari JV,et al.Platelets and fibrin(ogen)increase metastatic potential by impeding natural killer cell-mediated elimination of tumor cells[J].Blood,2005,105(1):178-185.
15 喻靓,张煜,卢仁泉.Cys C、β2-MG、RBP、MAU在肿瘤患者化疗后早期肾损伤中的临床意义[J].中国肿瘤,2015,24(4):340-343.

[1]	王晓雅,肖斌,廖扬,唐荣芝,孙朝晖,李林海. CXCR家族蛋白在不同乳腺癌亚型中的表达及临床预后分析[J]. 实用肿瘤学杂志, 2019, 33(3): 206-210.
[2]	冯越,邢丽楠,王棹,张云艳. NLR与肿瘤同步放化疗预后的相关性研究[J]. 实用肿瘤学杂志, 2019, 33(3): 284-288.
[3]	吕博文, 钱钧, 王杰, 钱景荣, 卢莹莹, 苏丽菊, 杨桐树, 李文辉. miR-455-5p在上皮性卵巢癌中表达研究及其靶基因功能分析[J]. 实用肿瘤学杂志, 2019, 33(2): 115-121.
[4]	白晓斌, 霍龙伟, 谢万福, 徐高峰, 王茂德. Chk1在胶质母细胞瘤中的表达及其与肿瘤生物学行为和预后生存的关联性[J]. 实用肿瘤学杂志, 2019, 33(2): 122-127.
[5]	石小康, 丁佑铭, 汪斌, 余斌, 徐雨. UBE2T在原发性肝癌中的表达及临床意义[J]. 实用肿瘤学杂志, 2019, 33(2): 128-133.
[6]	卢姣云, 张清媛. 实验室标志物在弥漫大B细胞淋巴瘤预后中的研究进展[J]. 实用肿瘤学杂志, 2019, 33(2): 183-187.
[7]	赵凤娟, 王琪, 任贇虹, 韦珏伶, 黎乐群, 赵新华, 唐娟, 游雪梅. 肝癌伴抑郁患者血清CRP、hs-CRP水平变化及其对预后的影响[J]. 实用肿瘤学杂志, 2019, 33(1): 27-33.
[8]	张凤春, 江莺, 刘照南, 闫宁宁, 崔洪全, 徐迎春. 系统性炎症相关指标中性粒细胞/淋巴细胞比值及血小板/淋巴细胞比值在根治性切除术后的胃癌患者的预后意义[J]. 实用肿瘤学杂志, 2019, 33(1): 34-39.
[9]	马健力, 张明辉, 姬宏飞, 徐向英. PD-L1蛋白与CD8⁺TILs联合检测在可切除肺腺癌预后评估中的临床意义[J]. 实用肿瘤学杂志, 2019, 33(1): 40-46.
[10]	杨洪波, 石洁, 叶勇, 李文成, 邓兆平. COL5A2在膀胱癌组织中的表达及其与临床病理特征和预后的相关性分析[J]. 实用肿瘤学杂志, 2019, 33(1): 52-56.
[11]	宋玲, 付琼. 紫云英苷通过抑制HIF-1α诱导的糖酵解途径发挥抗卵巢肿细胞作用的研究[J]. 实用肿瘤学杂志, 2018, 32(6): 503-509.
[12]	王亚龙, 吕章艳, 张帆, 冯小双, 魏锣沛, 李鑫, 温艳, 高禹舜, 薛奇, 高树庚, 谭锋维. 人乳头状瘤病毒感染与肺癌预后相关性的Meta分析[J]. 实用肿瘤学杂志, 2018, 32(6): 520-526.
[13]	唐淑丽, 何匡邦, 张纯慧, 程佳楠, 张艳桥. 胃癌组织中miR-320a和CYLD的表达及与临床病理特征及预后的关系[J]. 实用肿瘤学杂志, 2018, 32(6): 538-544.
[14]	肖洪伟, 陈升, 王艳良, 苏学良. 距肛缘≤8 cm的T₁期直肠癌患者经肛门局部切除术的预后及影响因素分析[J]. 实用肿瘤学杂志, 2018, 32(6): 545-549.
[15]	王一然, 黄维, 尹蕾, 刘琳, 周晓平, 牛星鉴, 杨悦, 安巍巍, 姬宏飞. 中性粒细胞与淋巴细胞比值对宫颈癌患者同步放化疗疗效及预后判断的临床意义[J]. 实用肿瘤学杂志, 2018, 32(5): 404-409.