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目的:分析卵巢上皮癌对铂类为基础的联合一线化疗的耐药情况,探讨初治化疗敏感性对预后的影响。方法:按初治后无瘤间期(DFI)长短将患者分为铂耐药、铂部分敏感、铂敏感3组,比较各组患者的临床特征、复发治疗及预后情况。结果:244例患者的中位发病年龄52岁,晚期占72.1%,61.1%为浆液性,67.2%为低分化,淋巴转移率31.2%,原发耐药比率23.36%,总5年生存率54.7%,中位总生存时间(OS)为70个月,中位无疾病进展时间(PFS)为29个月。晚期、未达到满意肿瘤细胞减灭术的患者铂耐药几率增高(P<0.001,P<0.001)。铂耐药患者的CA125及淋巴转移率高于铂敏感组(P=0.03,P=0.003)。3组患者中任意两组的OS及PFS均有显著差异(P<0.001)。部分敏感患者复发后,更换化疗方案者中位OS较继续TC(TP)或CAP化疗者略长(P=0.196)。结论:中低分化的晚期患者,CA125超过1000U/ml,未达到满意肿瘤细胞减灭术,盆腔、腹主动脉旁淋巴结阳性,耐药或部分敏感的几率高,预后差。化疗敏感性不同的患者预后不同,复发后应选择不同的化疗方案。
OBJECTIVE: To analyze the resistance of ovarian epithelial carcinoma to platinum-based combination of first-line chemotherapy and to explore the influence of the chemosensitivity of the initial treatment on the prognosis. Methods: The patients were divided into three groups: platinum-resistant, platinum-sensitive and platinum-sensitive. The clinical characteristics, recurrence and prognosis were compared between the two groups. Results: The median age of onset was 52 years in 244 patients, 72.1% in late stage, 61.1% was serous, 67.2% was poorly differentiated, lymph node metastasis rate was 31.2%, primary drug resistance rate was 23.36% and total 5-year survival rate was 54.7 %, The median overall survival (OS) was 70 months, and the median progression-free time (PFS) was 29 months. In the advanced stage, patients who did not achieve satisfactory tumor cytoreduction had an increased platinum resistance (P <0.001, P <0.001). Patients with platinum resistance had higher CA125 and lymphatic metastasis than those with platinum sensitivity (P = 0.03, P = 0.003). There was a significant difference in OS and PFS between any two groups in the 3 groups (P <0.001). After the relapse of some sensitive patients, the median OS in patients who switched to chemotherapy was slightly longer than those who continued with TC (TP) or CAP chemotherapy (P = 0.196). CONCLUSIONS: In patients with moderate or poor differentiation, CA125 is more than 1000 U / ml, which is not satisfactory for tumor cytoreductive surgery. The pelvic and para-aortic lymph nodes are positive, and the drug-resistant or partially sensitive is highly likely. The prognosis is poor. Different patients with different chemosensitivity prognosis, recurrence should choose a different chemotherapy.