新辅助化疗在治疗晚期卵巢癌中的应用进展

△△△※730000Ｒ691A1006-2084201524-4483-03doi10.3969/j.issn.1006-2084.2015.24.022PDS。NACTPDS。NACT。NACTPDS。NACT。TheApplicationProgressofNeoadjuvantChemotherapyintheTreatmentofAdvancedOvarianCancerZHANGMiaoLIUYanZHANGJieWANGXiao-Hui．DepartmentofGynecologyandobstetricstheFirstHospitalofLanzhouUniversityLanzhou730030ChinaAbstractMaximalcytoreductivesurgeryisakeyfactoraffectingtheprognosisofpatientswithadvancedovariancancer．SomestudieshaveshownthatcytoreductivesurgeryafterneoadjuvantchemotherapyNACTcomparedwithprimarydebulkingsurgeryPDSismorelikelytoachievethestateofnoresidualtumorwithreducedintraoperativeandpostoperativecomplications．ThereforeNACTcanimprovethequalityoflifeandtheprognosisofpatientswithadvancedovariancancerthushasacertainclinicalvalue．HoweverthereisnoconclusiveevidencethatsurgeryafterNACTcanbetterimprovethesurvivalrateofpatients．HerereviewstheapplicationprogressofNACTtreatmentforadvancedovariancancer．KeywordsAdvancedovariancancerNeoadjuvantchemotherapyApplicationprogressTherapy、、。neoadju-vantchemotherapyNACT、、、。Ⅲ～ⅣNACT。NACT。1NACT1.1NACT650.36%0.64%18.14/103.13/102。SalaniBristow320122188013000。。12500075%ⅢⅣ4520%～25%5。6。NACT78、NACT、。1.2NACTNACT、、1254、、/X、NACT。NACT、Vergote9NACT①＞1g②＞100g、1000g、＞10g、。Hou10CT、、、、、、。≥1cmNACTinternaldebulkingsurgeryIDS11。2NACT＜1cmprimarydebulkingsurgeryPDSNACTNACT12、NACT。NACT·3844·2015122124MedicalＲecapitulateDec．2015Vol．21No．24。NACT13。NACTIDSPDS、、。14200952012510050NACT++、1NACT-IDSPDS、。KangNam15125＞2000kU/LNACTprogression-freesurvivalPFS。NACTⅣPDSⅣ。Vergote16ⅢCⅣ670PDSNACT-IDS≤1cmPDS41.6%NACT-IDS80.6%、、、、PDSNACT-IDSPFS。Kehoe172004～2010Ⅲ/ⅣPDSNACT16%40%5.6%140.5%1。22.8、24.5HＲ=0.87NACT80%CI0.76～0.98PFS10.211.7HＲ=0.9180%CI0.81～1.02NACT-IDS。Fag-Olsen18NACT-IDSn=515PDSn=990PDSNACT-IDS2HＲ=1.8195%CI1.81～1.39P＜0.0001。NACTPFS。3NACT3.1NACTdaCostaMiranda1982NACT6～85～6175mg/m221d5%80.5%1012.1%。Vergote16NACT19.4%、NACT-PDS51.2%。6NACT63.6%。Thrall205785PDSNACT-IDS、、637.5BristowChi21PDS24.56NACT、NACT。PDS。Bilici23PDS4NACTIDS。Taskin234NACT24。32～3321d。3.2NACT、、NACT25。3.3NACT。NACT、、NACT3mm。Petrillo26322NACT-IDS216.5%10432.3%microPＲ＜3mm19761.2%macroPＲPFS36microPＲmacroPＲPFS16、13P=0.001。72microPＲmacroPＲ38、29P=0.018。CPＲmicroPＲP=0.81。microPＲmacroPＲP=0.87PFS。·4844·2015122124MedicalＲecapitulateDec．2015Vol．21No．24。3.4GoldieColdman2720、。NACT。3.5、、、、。4NACTPFS。NACT。NACT2～3NACTⅢⅣ22。NACT7028。NACTNACT。NACT。1FerlayJSoerjomataramIDikshitＲetal．CancerincidenceandmortalityworldwideSourcesmethodsandmajorpatternsinGLOB-OCAN2012J．IntJCancer20151365E359-386.2．M．200988-89．3SalaniＲBristowＲE．SurgicalmanangementofepithelialovariancancerJ．ClinObstetGynecol201255175-95.4SankaranarayananＲFerlayJ．WorldwideburdenofgynaecologicalcancerthesizeoftheproblemJ．ClinObstetGynecol2006202207-225.5OzolsＲF．TreatmentgoalsinovariancancerJ．IntJGynecolCancer200515Suppl13-11.6BristowＲETomacruzＲSArmstrongDKetal．Survivaleffectofmaximalcytoreductivesurgeryforadvancedovariancarcinomadur-ingtheplatinumeraameta-analysisJ．JClinOncol20022051248-1259.7MatagaVMatkoviV．ＲoleofneoadjuvantchemotherapyintheadvancedovariancancerJ．LijecVjesn20131351/221-26.8．J．201163353-54.9VergoteIDeWeverITialmaWetal．IntervaldebulkingsurgeryanalternativeforprimarysurgicaldebulkingJ．SeminSurqOncol200019149-53.10HouJYKellyMGYuHetal．NeoadjuvantchemotherapylessenssurgicalmorbidityinadvancedovariancancerandleadstoimprovedsurvivalinstageⅣdiseaseJ．GynecolOncol20071051211-217.11MurajiMSudoTIwasakiSetal．HistopathologypredictsclinicaloutcomeinadvancedepithelialovariancancerpatientstreatedwithneoadjuvantchemotherapyanddebulkingsurgeryJ．GynecolOncol20131313531-534.12HynninenJLavoniusMOksaSetal．Isperioperativevisualesti-mationofintra-abdominaltumorspreadreliableinovariancancersurgeryafterneoadjuvantchemotherapyJ．GynecolOncol20131282229-232.13WeinberqLEＲodriquezGHurteauJAetal．Theroleofneoadju-vantchemotherapyintreatingadvancedepithelialovariancancerJ．JSurqOncol20101014334-343.14．J．201211231882-1883.15KangSNamBH．DoesNeoadjuvantChemotherapyIncreaseOpti-malCytoreductionＲateinAdvancedOvarianCancerMeta-Analysisof21StudiesJ．AnnSurqOncol20091682315-2320.16VergoteITropeCGAmantFetal．NeoadjuvantchemotherapyorprimarysurgeryinstageⅢCorⅣovariancancerJ．NEnqlJMed201036310943-953.17KehoeSHookJNankivellMetal．Chemotherapyofupfrontsur-geryfornewlydiagnosedadvancedovariancancerresultsfromtheMＲCCHOＲUStrialJ．ClinOncol20131315500.18Fag-OlsenCLOttesenBKehletHetal．Doesneoadjuvantchemotherapyimpairlong-termsurvivalforovariancancerpatientsAnationwideDanishstudyJ．GynecolOncol20141322292-298.19daCostaMirandaVdeSouzaFêdeBDosAnjosCHetal．Neo-adjuvantchemotherapywithsixcyclesofcarboplatinandpaclitaxelinadvancedovariancancerpatientsunsuitableforprimarysurgerySafetyandeffectivenessJ．GynecolOncol20141322287-291.20ThrallMMGrayHJSymonsＲGetal．NeoadjuvantchemotherapyintheMedicarecohortwithadvancedovariancancerJ．GynecolOncol20111233461-466.21BristowＲEChiDS．Platinum-basedneoadjuvantchemotherapyandintervalsurgicalcytoreductionforadvancedovariancancerameta-analysisJ．GynecolOncol200610331070-1076.22BiliciASalepciTDaneFetal．Neoadjuvant