卵巢癌是致死率最高的女性生殖系统肿瘤,近年有关其发生机制的研究进展从根本上挑战了经典理论,很多传统观念将被改变.在此,我们对有关卵巢癌发病机制研究的新进展进行简要介绍.一、卵巢癌发病总体模型
卵巢上皮性癌(卵巢癌)是病死率最高的妇科恶性肿瘤,尽管手术技巧的提高可以做到最大限度的肿瘤切除,铂类、紫杉醇类以及二线化学药物治疗(化疗)的临床应用,给患者带来多重生机,但是,卵巢癌患者的5年生存率仍无明显提高.其主要原因,一是70%以上的卵巢癌诊断时,病变范围已超出卵巢,属于晚期;二是虽然很多患者对最初的治疗会有反应,但大多数病变在一个相当短的疾病缓解期后复发或者出现疾病进展;三是患者容易对化疗药物产生耐药;四是临床治疗不规范.因此,为了进一步提高卵巢癌的治疗效果,在诊断和治疗过程中应注意以下几个问题.
Objective: To investigate the relationship between the prognosis of Epithelial Ovarian Cancer (EOC) and its ascites. Methods: Retrospectively analysis is performed for the clinical, pathological and followed up data of 101 in-patients suffering from epithelial ovarian cancer and operated with tumor debulking surgery in our hospital from January 1986 to December 1993. The patients was divided into two groups based upon the first laparotomy finding with ascites(62) or without(39). Age average, cell type, advanced proportion and survival rate of the patients are evaluated by a c2 test. Results: For age average and cell type, no statistical difference was noted. However, there were more advanced cases in ascites group than in the other (P<0.01). The 3-, 4- and 5-year survival in the no-ascites group were 87.02%, 73.42%, 57.10% respectively compared with 65.02%, 38.66%, 28.12% in the ascites group. The 5-year survival rate of stage I, II,III, IV patients in no-ascites group are 77%, 70%, 41.1%, 0 respectively, compared with that of 60%, 56.8%, 15.46%, 0 respectively in the ascites group. The results shows that 3-, 4-, and 5-year survival in no-ascites group were significantly higher than those in ascites group(P<0.01). Conclusion: Presence of ascites is a factor of poor prognosis for EOC.
发病率卵巢癌在女性常见癌症中(皮肤癌除外)位列第九,在癌症所致的女性死亡原因中居第五位.女性在一生中患卵巢漫润癌的风险是1/71,而死于卵巢浸润癌的风险是1/95.在美国,据估计每年有21 550例的新发病例,且有14600人死于卵巢癌.然而,在世界不同地区卵巢癌的发病率大不相同,2004年欧盟国家估计每年新发病例42 700例,而病死率为12/10万.这些患者中大多死于浆液性卵巢癌,且约半数诊断为卵巢癌的患者年龄都超过60岁.因此,尽管每年世界范围内的新发病例一半以上源于发展中国家,但在西方国家卵巢癌的防治已成为一项非常重要的公共卫生事业.
在女性生殖道肿瘤中,卵巢癌患病率位居第3位,且病死率最高.即使行理想的肿瘤减灭术以及规范的化疗方案,晚期卵巢癌患者生存率仍然很低.因此,寻找有效的卵巢癌治疗方法是许多学者的研究目标.包括卵巢癌在内的许多种恶性肿瘤、均已被证明具有免疫原性.一些抗肿瘤因子与癌症有关联的最有力证据是通过对卵巢癌的研究被发现的.近20多年来进行了许多有关卵巢癌免疫治疗的临床试验,但结论却不尽明确.
