目的探讨新辅助化疗联合间隔减瘤术(neoadjuvant chemotherapy followed by interval debulking surgery,NACT/IDS)在晚期卵巢癌中的临床应用价值。方法回顾性分析上海交通大学附属瑞金医院2000年6月至2013年1月109例IIIc和IV期晚期卵...目的探讨新辅助化疗联合间隔减瘤术(neoadjuvant chemotherapy followed by interval debulking surgery,NACT/IDS)在晚期卵巢癌中的临床应用价值。方法回顾性分析上海交通大学附属瑞金医院2000年6月至2013年1月109例IIIc和IV期晚期卵巢癌患者资料,将53例直接行肿瘤减灭术(primary debulking surgery,PDS)患者纳入PDS组,将56例行NACT/IDS患者纳入NACT/IDS组,比较两组的生存率及围手术期情况。结果两组患者术后总生存率(overall survival,OS)和无病进展期(progression-free survival,PFS)比较差异均无统计学意义(P>0.05)。NACT/IDS组手术切除率(53.6%)明显高于PDS组(43.4%)(P<0.05);NACT/IDS组手术出血量、术后恢复、并发症的发生情况优于PDS组(P<0.05)。结论 NACT/IDS增加了手术切除率,减少了手术创伤,术后生存率与PDS无明显差异。在Ⅲc期和Ⅳ期卵巢癌患者,并非强调直接行PDS,NACT/IDS是有效的治疗方法。展开更多
目的探讨晚期上皮性卵巢癌腹腔镜初次肿瘤细胞减灭术的可行性和安全性。方法回顾性分析2010年1月~2019年12月肿瘤直径≤10 cm的国际妇产科联盟(International Federation of Gynecology and Obstetrics,FIGO)手术病理分期为Ⅲa~Ⅳ期上...目的探讨晚期上皮性卵巢癌腹腔镜初次肿瘤细胞减灭术的可行性和安全性。方法回顾性分析2010年1月~2019年12月肿瘤直径≤10 cm的国际妇产科联盟(International Federation of Gynecology and Obstetrics,FIGO)手术病理分期为Ⅲa~Ⅳ期上皮性卵巢癌126例资料,行腹腔镜手术50例,开腹手术76例。2组年龄、BMI、肿瘤直径、手术病理分期、病理类型和病理分级差异均无统计学意义(P>0.05)。比较2组手术参数及随访结果。结果与开腹组相比,腹腔镜组手术时间短[(344.6±125.9)min vs.(443.1±124.2)min,t=-4.335,P=0.000],出血少[中位数200(20~2000)ml vs.600(50~3500)ml,Z=-6.241,P=0.000],术后排气早[2(1~7)d vs.4(1~13)d,Z=-5.380,P=0.000],开始化疗早[11.5(3~39)d vs.15.5(8~65)d,Z=-2.724,P=0.006],但肿瘤细胞减灭术满意率低[32.0%(26/50)vs.64.5%(49/76),χ2=12.734,P=0.000]。2组并发症发生率差异无统计学意义(P=0.960)。腹腔镜组和开腹组无进展生存期(中位数35月vs.27月,log-rankχ2=0.861,P=0.353)和总生存率(3年生存率86.6%vs.77.6%,5年生存率70.0%vs.58.9%,log-rankχ2=1.381,P=0.240)差异均无统计学意义。结论经过严格选择的晚期上皮性卵巢癌行腹腔镜初次肿瘤细胞减灭术是可行的,其预后并不逊于开腹手术。展开更多
目的:比较初次肿瘤细胞减灭术(PDS)与中间性肿瘤细胞减灭术(IDS)对晚期卵巢癌患者远期生存的影响。方法:收集自2018年1月至2018年6月于中国科学技术大学附属第一医院妇瘤科手术(PDS/IDS)的晚期上皮性卵巢癌(III-IVB期)患者,从其生存期(...目的:比较初次肿瘤细胞减灭术(PDS)与中间性肿瘤细胞减灭术(IDS)对晚期卵巢癌患者远期生存的影响。方法:收集自2018年1月至2018年6月于中国科学技术大学附属第一医院妇瘤科手术(PDS/IDS)的晚期上皮性卵巢癌(III-IVB期)患者,从其生存期(OS)、严重手术并发症发生率等方面对比两种术式。采用Kaplan-Meier法分析生存曲线,采用log-rank检验比较生存差异,采用Cox比例风险回归模型分析影响生存的危险因素。结果:共纳入76例患者,其中IDS组24例,PDS组52例。两组患者在年龄、营养评分、术前血红蛋白(Hb)水平、组织病理学类型、临床分期等方面无统计学差异(P>0.05)。IDS组术中出血量显著低于PDS组(1045.83±981.91 mL vs 1628.85±1168.72 mL,P<0.01)。IDS组严重手术并发症发生率显著低于PDS组(12.5%vs 36.5%,P<0.05)。随访期间,IDS组共9例死亡,PDS组共16例死亡。IDS组的中位OS为47.0个月,PDS组的中位OS为38.0个月,两组间的OS差异无统计学意义(P=0.17)。多因素Cox回归分析显示,术中出血量(HR=1.001,95%CI=1.000-1.002,P=0.03)和严重手术并发症(HR=2.345,95%CI=1.123-4.902,P=0.02)是影响OS的独立危险因素,而术式(PDS/IDS)不是影响OS的独立危险因素(HR=0.667,95%CI=0.302-1.473,P=0.32)。结论:对于晚期卵巢癌患者,IDS与PDS相比,可以减少术中出血量和严重手术并发症的发生率,但对远期生存无显著影响。术中出血量和严重手术并发症是影响远期生存的独立危险因素,应尽量避免。展开更多
<strong>Introduction:</strong><span style="font-family:Verdana;"><span style="font-family:Verdana;"><span style="font-family:Verdana;"> This study evaluated ...<strong>Introduction:</strong><span style="font-family:Verdana;"><span style="font-family:Verdana;"><span style="font-family:Verdana;"> This study evaluated the difference in operative and clinica</span></span></span><span><span><span style="font-family:""><span style="font-family:Verdana;">l outc</span><span style="font-family:Verdana;">omes for patients with advanced ovarian cancer after primary debulking</span><span style="font-family:Verdana;"> surgery (PDS) versus neoadjuvant chemotherapy (NACT) followed by interval debul</span><span><span style="font-family:Verdana;">king surgery (IDS) in Bangladesh. </span><b><span style="font-family:Verdana;">Methods:</span></b><span style="font-family:Verdana;"> Sixty patients with a</span></span><span style="font-family:Verdana;">dvanced epit</span><span style="font-family:Verdana;">helial ovarian cancer presenting to the department of Gynaecologi</span><span style="font-family:Verdana;">cal Oncology at the National Institute of Cancer Research and Hospital were prospectively enrolled. Thirty patients underwent primary debulking surgery and thirty patients received NACT followed by IDS. </span><b><span style="font-family:Verdana;">Results:</span></b><span style="font-family:Verdana;"> In the PDS and IDS groups respectively, 56.7% and 50% of patients presented with stage IIIC and 67.7% and 56.7% respectively had ser</span></span></span></span><span style="font-family:Verdana;"><span style="font-family:Verdana;"><span style="font-family:Verdana;">i</span></span></span><span style="font-family:Verdana;"><span style="font-family:Verdana;"><span style="font-family:Verdana;">ous papillary type histopathology. Duration of surgery, amount of blood loss and total hospital stay were significantly lower (p < 0.001) in IDS group than </span></span></span><span style="font-family:Verdana;"><span style="font-family:Verdana;"><span style="font-family:Verdana;">in </span></span></span><span><span><span style="font-family:""><span style="font-family:Verdana;">the PDS group. There was a 展开更多
Although it is assumed that the combination of chemotherapy and radical surgery should be indicated in all newly diagnosed advanced-stage ovarian cancer patients, one of the main raised questions is how to select the ...Although it is assumed that the combination of chemotherapy and radical surgery should be indicated in all newly diagnosed advanced-stage ovarian cancer patients, one of the main raised questions is how to select the best strategy of initial treatment in this group of patients, neoadjuvant chemotherapy followed by interval debulking surgery or primary debulking surgery followed by adjuvant chemotherapy. The selection criteria to offer one strategy over the other as well as a stepwise patient selection for initial treatment are described. Selecting the best strategy of treatment in newly diagnosed advanced stage ovarian cancer patients is a multifactorial and multidisciplinary decision. Several factors should be taken into consideration:(1) the disease factor, related to the extension and localization of the disease as well as tumor biology;(2) the patient factor, associated with patient age, poor performance status, and co-morbidities; and(3) institutional infrastructure factor, related to the lack of prolonged operative time, an appropriate surgical armamentarium, as well as well-equipped intensive care units with well-trained personnel.展开更多
文摘目的:比较初次肿瘤细胞减灭术(PDS)与中间性肿瘤细胞减灭术(IDS)对晚期卵巢癌患者远期生存的影响。方法:收集自2018年1月至2018年6月于中国科学技术大学附属第一医院妇瘤科手术(PDS/IDS)的晚期上皮性卵巢癌(III-IVB期)患者,从其生存期(OS)、严重手术并发症发生率等方面对比两种术式。采用Kaplan-Meier法分析生存曲线,采用log-rank检验比较生存差异,采用Cox比例风险回归模型分析影响生存的危险因素。结果:共纳入76例患者,其中IDS组24例,PDS组52例。两组患者在年龄、营养评分、术前血红蛋白(Hb)水平、组织病理学类型、临床分期等方面无统计学差异(P>0.05)。IDS组术中出血量显著低于PDS组(1045.83±981.91 mL vs 1628.85±1168.72 mL,P<0.01)。IDS组严重手术并发症发生率显著低于PDS组(12.5%vs 36.5%,P<0.05)。随访期间,IDS组共9例死亡,PDS组共16例死亡。IDS组的中位OS为47.0个月,PDS组的中位OS为38.0个月,两组间的OS差异无统计学意义(P=0.17)。多因素Cox回归分析显示,术中出血量(HR=1.001,95%CI=1.000-1.002,P=0.03)和严重手术并发症(HR=2.345,95%CI=1.123-4.902,P=0.02)是影响OS的独立危险因素,而术式(PDS/IDS)不是影响OS的独立危险因素(HR=0.667,95%CI=0.302-1.473,P=0.32)。结论:对于晚期卵巢癌患者,IDS与PDS相比,可以减少术中出血量和严重手术并发症的发生率,但对远期生存无显著影响。术中出血量和严重手术并发症是影响远期生存的独立危险因素,应尽量避免。
文摘<strong>Introduction:</strong><span style="font-family:Verdana;"><span style="font-family:Verdana;"><span style="font-family:Verdana;"> This study evaluated the difference in operative and clinica</span></span></span><span><span><span style="font-family:""><span style="font-family:Verdana;">l outc</span><span style="font-family:Verdana;">omes for patients with advanced ovarian cancer after primary debulking</span><span style="font-family:Verdana;"> surgery (PDS) versus neoadjuvant chemotherapy (NACT) followed by interval debul</span><span><span style="font-family:Verdana;">king surgery (IDS) in Bangladesh. </span><b><span style="font-family:Verdana;">Methods:</span></b><span style="font-family:Verdana;"> Sixty patients with a</span></span><span style="font-family:Verdana;">dvanced epit</span><span style="font-family:Verdana;">helial ovarian cancer presenting to the department of Gynaecologi</span><span style="font-family:Verdana;">cal Oncology at the National Institute of Cancer Research and Hospital were prospectively enrolled. Thirty patients underwent primary debulking surgery and thirty patients received NACT followed by IDS. </span><b><span style="font-family:Verdana;">Results:</span></b><span style="font-family:Verdana;"> In the PDS and IDS groups respectively, 56.7% and 50% of patients presented with stage IIIC and 67.7% and 56.7% respectively had ser</span></span></span></span><span style="font-family:Verdana;"><span style="font-family:Verdana;"><span style="font-family:Verdana;">i</span></span></span><span style="font-family:Verdana;"><span style="font-family:Verdana;"><span style="font-family:Verdana;">ous papillary type histopathology. Duration of surgery, amount of blood loss and total hospital stay were significantly lower (p < 0.001) in IDS group than </span></span></span><span style="font-family:Verdana;"><span style="font-family:Verdana;"><span style="font-family:Verdana;">in </span></span></span><span><span><span style="font-family:""><span style="font-family:Verdana;">the PDS group. There was a
文摘Although it is assumed that the combination of chemotherapy and radical surgery should be indicated in all newly diagnosed advanced-stage ovarian cancer patients, one of the main raised questions is how to select the best strategy of initial treatment in this group of patients, neoadjuvant chemotherapy followed by interval debulking surgery or primary debulking surgery followed by adjuvant chemotherapy. The selection criteria to offer one strategy over the other as well as a stepwise patient selection for initial treatment are described. Selecting the best strategy of treatment in newly diagnosed advanced stage ovarian cancer patients is a multifactorial and multidisciplinary decision. Several factors should be taken into consideration:(1) the disease factor, related to the extension and localization of the disease as well as tumor biology;(2) the patient factor, associated with patient age, poor performance status, and co-morbidities; and(3) institutional infrastructure factor, related to the lack of prolonged operative time, an appropriate surgical armamentarium, as well as well-equipped intensive care units with well-trained personnel.
