本文選題：二次腫瘤細(xì)胞減滅術(shù)　切入點(diǎn)：復(fù)發(fā)性卵巢癌　出處：《吉林大學(xué)》2017年碩士論文　論文類型：學(xué)位論文

【摘要】：目的:卵巢癌是女性常見腫瘤,80%~90%患者在初始治療后可達(dá)到臨床緩解,但仍有60%~70%的患者最終復(fù)發(fā),復(fù)發(fā)后的治療尚無統(tǒng)一標(biāo)準(zhǔn)�，F(xiàn)有研究支持二次腫瘤細(xì)胞減滅術(shù)可延長鉑類敏感的復(fù)發(fā)性卵巢癌患者總生存期,但大部分的為回顧性研究,部分為前瞻性試驗(yàn),僅有的隨機(jī)對照試驗(yàn)正在進(jìn)行。本文收集已發(fā)表的關(guān)于二次腫瘤細(xì)胞減滅術(shù)在鉑類敏感復(fù)發(fā)性卵巢癌患者中作用的相關(guān)研究,系統(tǒng)評價(jià)二次腫瘤細(xì)胞減滅術(shù)對比單純化療對復(fù)發(fā)性卵巢癌患者生存期的影響,及二次腫瘤細(xì)胞減滅術(shù)后達(dá)到無肉眼殘留腫瘤對比有任何體積的殘留腫瘤對復(fù)發(fā)性卵巢癌患者生存期的影響。方法:計(jì)算機(jī)檢索Cochrane圖書館、Pub Med、Embase、Clinicaltrials、中國生物醫(yī)學(xué)文獻(xiàn)數(shù)據(jù)庫(CBM)、相關(guān)期刊論文(CNKI)、萬方數(shù)據(jù)庫,手工檢索所有當(dāng)前能夠檢索到的參考資料及研究報(bào)告,檢索時(shí)間均從建庫至2016年10月。由2位評價(jià)員獨(dú)立篩選文獻(xiàn)、提取資料并評價(jià)納入研究的偏倚風(fēng)險(xiǎn)后,采用Rev Man 5.3軟件進(jìn)行Meta分析。結(jié)果:最終納入21篇研究,5375例患者。納入研究進(jìn)行定性分析:平均年齡55.41歲,平均隨訪時(shí)間為36.96個(gè)月,復(fù)發(fā)前的平均中位無進(jìn)展生存期為20.95個(gè)月,術(shù)后平均中位生存時(shí)間為35.01個(gè)月,平均中位無進(jìn)展生存期為18個(gè)月,手術(shù)時(shí)間247分鐘(26-600分鐘),術(shù)中出血量524ml(50-6000ml),無肉眼殘留腫瘤手術(shù)切除率為57.72%(38%-82.1%),滿意腫瘤細(xì)胞減滅術(shù)手術(shù)切除率為70.35%(38.3%-89.36%),手術(shù)并發(fā)癥發(fā)生率為4.1%-43.3%,手術(shù)死亡率為1.12%。Meta分析結(jié)果顯示:與單純化療相比,二次腫瘤細(xì)胞減滅術(shù)能夠延長具有有利預(yù)后因素的復(fù)發(fā)性卵巢癌患者的總生存期(HR=1.34,95%CI(1.22-1.46),P0.00001)�？偵嫫诒容^亞組分析結(jié)果提示,二次腫瘤細(xì)胞減滅術(shù)后殘留腫瘤(RD)0cm對比RD=0cm,HR=3.10,95%CI(2.25-4.27),P0.0001;RD≤0.5cm對比RD=0cm,HR=2.86,95%CI(1.38-5.90),P=0.0.005;RD≤1.0cm對比RD=0cm,HR=2.91,95%CI(2.36-3.59),P0.00001;RD1.0cm對比RD=0cm,HR=5.86,95%CI(4.42-7.77),P0.00001;RD2.0cm對比RD=0cm,HR=2.56,95%CI(1.45-4.52),P=0.001。合并亞組Meta分析結(jié)果提示,與二次腫瘤細(xì)胞減滅術(shù)達(dá)到無任何體積殘留腫瘤相比,達(dá)到無肉眼殘留腫瘤的手術(shù)可延長手術(shù)患者的生存期(HR=3.37,95%CI 2.84-3.99,P0.00001)。納入研究中僅有2項(xiàng)對比二次腫瘤細(xì)胞減滅術(shù)與單純化療患者的生存質(zhì)量,均提示手術(shù)對復(fù)發(fā)患者的生存質(zhì)量的并無影響。結(jié)論:1.二次腫瘤細(xì)胞減滅術(shù)及術(shù)后繼續(xù)化療可延長具有良好預(yù)后因素的鉑類敏感復(fù)發(fā)性卵巢癌患者的總生存期,且具備的有利預(yù)后因素越多,達(dá)到滿意程度的二次腫瘤細(xì)胞減滅術(shù)的比率就越高,但尚無統(tǒng)一的手術(shù)風(fēng)險(xiǎn)預(yù)測或評分模型,因此在為復(fù)發(fā)患者選擇治療方案時(shí),仍需綜合評定做出個(gè)體化的選擇。2.達(dá)到無肉眼可見殘留腫瘤的二次腫瘤細(xì)胞減滅術(shù)可顯著延長復(fù)發(fā)性卵巢癌手術(shù)患者的總生存期,故在術(shù)中應(yīng)盡可能減滅所有肉眼可見腫瘤,使手術(shù)達(dá)到無肉眼可見殘留腫瘤的滿意手術(shù)效果,若不能達(dá)到則應(yīng)減滅腫瘤殘留體積于1cm內(nèi),才能使患者獲得相對較長的生存時(shí)間。3.評價(jià)二次腫瘤細(xì)胞減滅術(shù)在復(fù)發(fā)性卵巢癌的作用的隨機(jī)對照試驗(yàn)正在進(jìn)行,全面對比二次腫瘤細(xì)胞減滅術(shù)與單純化療的有效性、安全性以及生存質(zhì)量方面的差異,其數(shù)據(jù)及結(jié)論值得期待,可為二次腫瘤細(xì)胞減滅術(shù)在復(fù)發(fā)性卵巢癌患者中的作用提供更有力的證據(jù)支持。
[Abstract]:Objective: ovarian cancer is the most common cancer in women, 80%~90% patients reached clinical remission after initial therapy, but there are still 60%~70% patients eventually relapse, relapse after treatment has no uniform standards. The existing research supports two cytoreductive surgery can prolong the platinum sensitive recurrent total survival of patients with ovarian cancer, but most of the retrospective study is a prospective trial, a randomized controlled trial only is being carried out. This paper collects relevant published research on two tumor cell killing effect in the reduction of platinum sensitive recurrent ovarian cancer patients, system two evaluation of influence of tumor cell surgical debulking compared to chemotherapy alone in the treatment of recurrence ovarian cancer survival, and two times of cytoreductive surgery after reaching no gross residual tumor compared with the effect of the residual tumor volume of any recurrent ovarian cancer survival. Methods: A computer search of the Cochrane library, Pub Med, Embase, Clinicaltrials, Chinese biomedical literature database (CBM), China Journal Full-text Database (CNKI), Wanfang database, manual retrieval of all current access to reference and research reports, were searched from inception to October 2016. By 2 reviewers independently screened the literature. Extracted the data and assessed the risk of bias of included studies, using Rev Man 5.3 software for Meta analysis. Results: a total of 21 studies, 5375 patients were included in the study. Qualitative analysis: the average age of 55.41 years, the average follow-up time was 36.96 months, the average recurrence before the median progression free survival was 20.95 in August, the average postoperative median survival time was 35.01 months, median progression free survival was 18 months. The operative time was 247 minutes (26-600 minutes), the intraoperative blood loss was 524ml (50-6000ml), no gross residual tumor The resection rate was 57.72% (38%-82.1%), satisfactory cytoreductive resection rate was 70.35% (38.3%-89.36%), the complication rate was 4.1%-43.3%, the mortality rate of operation was 1.12%.Meta analysis results showed that: compared with chemotherapy, two secondary cytoreductive surgery can prolong overall survival with favorable prognosis in patients with recurrent ovarian cancer the factors (HR=1.34,95%CI (1.22-1.46), P0.00001). The total survival time between subgroup analysis showed that the two tumor cell reduction of residual tumor after cytoreductive surgery (RD) 0cm compared to RD=0cm, HR=3.10,95%CI (2.25-4.27), P0.0001; RD = 0.5cm (1.38-5.90) compared to RD=0cm, HR=2.86,95%CI, P=0.0.005; RD = 1.0cm RD=0cm (2.36-3.59), HR=2.91,95%CI, P0.00001; RD1.0cm compared to RD=0cm, HR=5.86,95%CI (4.42-7.77), P0.00001; RD2.0cm HR= 2.56,95%CI RD=0cm comparison (1.45-4.52), P=0.001. and Meta subgroup analysis showed that with the Two cytoreductive surgery achieved no residual tumor volume compared to no gross residual tumor surgical operation can prolong the survival of patients (HR=3.37,95%CI, 2.84-3.99, P0.00001). The quality of life in the study included only 2 compared to two secondary cytoreductive surgery and chemotherapy patients, showed that the operation had no effect the quality of life of patients with recurrence. Conclusion: 1. two tumor cells reduced overall survival after surgery and chemotherapy to destroy can prolong the good prognostic factors for platinum sensitive recurrent ovarian cancer patients, more favorable prognostic factors and have reached two times, the degree of satisfaction of reducing the ratio of tumor cells out of the higher, but the operation risk prediction score model or there is no uniform, so the treatment options for patients with recurrent, still need to make a choice of comprehensive evaluation of individual.2. reached no visible residual swelling Two tumor cell tumor cytoreductive surgery can significantly prolong overall survival of recurrent ovarian cancer patients, so as to eliminate all visible tumor should be in operation, the operation achieves satisfactory surgical results no visible residual tumor, if it can not reach should cytoreductive tumor residual volume in 1cm that can make the patient obtain relatively long survival time of.3. tumor cell reduction two evaluation of randomized controlled trials of cytoreductive surgery in recurrent ovarian cancer: role of ongoing, comprehensive comparison of the two tumor cell reduction effectiveness of cytoreductive surgery and chemotherapy, differences in safety and quality of life, the data and conclusions it is worth looking forward to but, cytoreductive surgery in patients with recurrent ovarian cancer in the role to provide more effective support for the two tumor cells.

【學(xué)位授予單位】：吉林大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2017
【分類號】：R737.31

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