卵巢癌化疗新进展Thestateoftheartinchemotherapyforovariancancers卵巢癌化疗新进展Thestateoftheartinchemotherapyforovariancancers复旦大学附属肿瘤医院妇瘤科女性生殖道肿瘤女性生殖道肿瘤::全世界统计全世界统计111.1.FerlayFerlayetal.etal.GLOBOCAN2000IARC,WHO2001(www.dep.iarc.fr)GLOBOCAN2000IARC,WHO2001(www.dep.iarc.fr)CancerCancerNewCasesNewCasesDeathsDeathsCervical470,000230,000Endometrial189,00045,000Ovarian192,000114,000Women发病率32%Breast12%Lung&bronchus11%Colon&rectum6%Uterinecorpus4%Ovary4%Non-Hodgkinlymphoma3%Melanomaofskin3%Thyroid2%Pancreas2%Urinarybladder20%AllOtherSites死亡率25%Lung&bronchus15%Breast11%Colon&rectum6%Pancreas5%Ovary4%Non-Hodgkinlymphoma4%Leukemia3%Uterinecorpus2%Brain/ONS2%Multiplemyeloma23%AllothersitesCancerFacts&Figures,ACSO,2003IncidencesofGynecologicalCancersinShanghaiCitizens(1974-2000)4.86.510.511.226.72.54.44.82.54.49.16.30510152025301974199419972000YearIncidences(/100,000)OvarianCancerCervicalCacnerEndometrialCancer上海市居民卵巢癌、宫颈癌、宫体癌发病率（1974-2000，SCDC）内容简介内容简介1.早期卵巢癌化疗2.中晚期卵巢癌化疗3.新辅助化疗/中间手术4.复发性卵巢癌化疗5.维持\巩固治疗6.Ca125升高处理卵巢癌的治疗卵巢癌的治疗未治患者主要目的是治愈手术分期和细胞减灭术，继而紫杉醇/铂类联合化疗复发患者主要目的是减轻症状和提高生活质量化疗可以延长生存时间最终结果长期存活:25-30%5-年生存率从30%(1970s)提高至>50%RiesLAGRiesLAGetal.SEERCancerStatisticsReview,1975-2001etal.SEERCancerStatisticsReview,1975-2001,NationalCancerInstitute.Bethesda,,NationalCancerInstitute.Bethesda,MD,MD,http://seer.cancer.gov/csr/1975http://seer.cancer.gov/csr/1975;2001/,2004.;2001/,2004.卵巢癌可认为是一种卵巢癌可认为是一种慢性疾病慢性疾病早期卵巢癌早期卵巢癌::FIGOIandIIFIGOIandII全面的分期剖腹探查术经腹全子宫/双侧卵巢输卵管切除(TAH/BSO)大网膜切除淋巴结切除术（dissection）腹膜和膈膜活检（biopsies）细胞学检查高危vs低危早期卵巢癌Stagingclassificationsandclinicalpracticeguidelinesofgynaecologiccancers.www.figo.orgStagingclassificationsandclinicalpracticeguidelinesofgynaecologiccancers.www.figo.org早期卵巢癌早期卵巢癌MedicalOncology:Acomprehensivereview.www.cancernetwork.comtextbookMedicalOncology:Acomprehensivereview.www.cancernetwork.comtextbook低危低危高危高危(5–10%复发率)(30–40%复发率)StageIAorIBStageIAorIBStageICStageICGrade1(or2)Grade3Clearcellcancer高危早期卵巢癌高危早期卵巢癌1.1.YoungSGO2003YoungSGO20032.YoungRC.SeminOncol27(3):8-10.,20002.YoungRC.SeminOncol27(3):8-10.,20003.ICON-1,EORTC-ACTION:JNatnlCanInst.Vol.95,No.2,January15,20033.ICON-1,EORTC-ACTION:JNatnlCanInst.Vol.95,No.2,January15,20034.Mannel4.Manneletal.etal.GOG-175protocol,www.cancernet.nci.nih.govGOG-175protocol,www.cancernet.nci.nih.govGOG–157GOG–1571,21,2辅助化疗的随机临床试验:3vs6疗程紫杉醇+卡铂结果6个疗程进展危险性降低了33%生存率无改善Action&IconAction&Icon33随机临床试验无立即化疗vs立即化疗结果立即化疗生存率提高8%vs复发时化疗(82%vs74%)FIGOStageIIIandIVFIGOStageIIIandIV定义定义III盆腔外腹膜种植和/或外阳性腹膜后或腹股沟淋巴结A病灶大致局限于真骨盆;淋巴结阴性;镜下腹腔种植B腹腔种植灶2cm;淋巴结阴性C腹腔种植灶>2cm和/或阳性腹膜后淋巴结或腹股沟IV远处转移MedicalOncology:Acomprehensivereview.MedicalOncology:Acomprehensivereview.www.cancernetwork.comtextbookwww.cancernetwork.comtextbook准确全面分期依据手术探查和病理组织学、细胞学检查根据腹腔内转移灶的大小对III期再分为IIIa、IIIb、IIIc腹...
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