目的 研究Ⅲ期、Ⅳ期上皮性卵巢癌(EOC)的预后影响因素。方法 回顾分析了最近12年本院收治的265例Ⅲ期、71例Ⅳ例EOC资料。采用寿命表法计算生存率，Kaplan-Meier描绘生存曲线，log-rank检验生存率差异；Cox逐步回归法分析影响预后的因素。结果 Ⅲ、Ⅳ期EOC总的5年生存率分别为21.97％、6.12％，残癌≤1 cm者的生存率分别达到38.56％、14.12％。Cox逐步回归分析结果表示，残留灶＞1cm(P=0 0000)、肿瘤侵犯子宫肌层(P=0.002 9)、有难治性腹水(P=0.000 0)和透明细胞癌(P=0.003 8)是影响Ⅲ期EOC总体生存率的危险因素；而黏液性癌和接受辅助静脉和腹腔化疗组预后好。另外残留灶大小、难治性腹水、新辅助化疗还与无疾病进展生存期(progression-free survival，PFS)有关。除残癌大小(P=0 001 4)外，腹水(P=0.004 3)还是Ⅳ期EOC的预后因素。结论 残癌大小、难治性腹水、组织类型、辅助化疗是晚期EOC的主要预后影响因素，腹水还是Ⅳ期EOC的预后影响因素。%Purpose To investigate the prognostic factors of survival in patients with advanced epithelialovarian cancer (EOC). Methods 265 and 71 patients with stage Ⅲ and stage Ⅳ EOC respectivelycomputerized statistical analyses, using SPSS software, were performed to estimate the survival. The survivalrate was calculated by life table, with survival difference tested by log-rank test. Cox stepwise regressionmodel was used to detect prognostic factors of survival. Results 120 (45.28 % ) stage Ⅲl patients wereoptimally cytoreduced during primary surger, with an estimated five-year survival of 38.56 %. Residualdisease was also a significant prognostic determinant of survival in patients with stage Ⅳ EOC, mainly inthose with malignant pleural effusion and surpraclavicular lymphadenopathy. Cox stepwise regression analysisrevealed that residual disease (P = 0. 000 0), the muscle of uteri corpus or cervix involved by the tumor(P = 0. 002 9), refractory ascites ( P = 0. 000 0), adjuvant chemotherapy, and cell types ( P = 0. 003 8 )were identified to be independent prognostic factors of survival for stage Ⅲ EOC patients. NeoadjuvaNtchemotherapy was associated with progression-free survival. Acites was also an independent prognosticfactors of survival for stage Ⅳ disease (P = 0. 004 3). Conclusions Residual disease, refractory aseit es,types of histology, and adjuvant chemotherapy were prognostic factors of survival for patients with advancedEOC. Besides residual disease, ascites was an important prognostic factors of survival of stage Ⅳ disease.
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