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至 2 0 0 2年 2月 ,有关晚期卵巢癌的手术治疗效果和细胞毒性化疗效果的临床证据如下 :⑴在改进生活质量方面的任何治疗效果的证据都不充分。⑵晚期卵巢癌的手术治疗 :①先行手术加化疗与单用化疗相比较 :缺乏相关RCT。②先行手术与不手术比较 :缺乏相关RCT。③在初次手术加化疗后一定间隔期的缩瘤术 :1个RCT发现 ,初次手术加化疗后一定间隔期的缩瘤术提高总的存活年限为 3 5年 ;另 1个RCT则认为该方法对存活率没有显著性作用 ,但可能系检验效能不够而没有发现潜在的临床重要作用。④常规二次手术 :2个RCT认为 ,在晚期卵巢癌初次手术后常规进行二探手术的存活率并不优于术后只进行化疗的对照组。⑶晚期卵巢癌的细胞毒性药物化疗 :①铂剂 +紫杉醇方案 :1篇系统评价和另 1个RCT认为 ,晚期卵巢癌初次手术后 ,以铂剂 +紫杉醇为基础的化疗能延长存活时间和总存活率。②含铂剂的化疗方案 :1篇系统评价发现 ,铂剂加入任何不含铂剂的方案都能显著提高存活率 ,尤其是铂剂加入联合治疗方案。③卡铂 +紫杉醇与卡铂 +多烯紫杉醇比较 :未找到比较这两种方案疗效的高质量RCT。④含铂剂的联合方案与不含铂剂的联合方案比较 :7个RCT比较了这两种方案 ;大多数RCT发现含铂剂的方案能改善结局 ,其益处和危害依赖于具体方案
As of February 2002, the clinical evidence for the surgical and cytotoxic chemotherapeutic effects on advanced ovarian cancer is as follows: (1) There is insufficient evidence of any therapeutic effect in improving quality of life. ⑵ surgical treatment of advanced ovarian cancer: ① first surgery plus chemotherapy compared with chemotherapy alone: the lack of related RCT. ② first surgery and no surgery: the lack of related RCT. ③ in the first surgery plus chemotherapy at certain intervals after the tumor: 1 RCT found that initial surgery plus chemotherapy at certain intervals of tumor shrinkage increased the total survival of 35 years; the other RCT that the method No significant effect on survival, but may not be enough to test the effectiveness of the discovery of a potential clinical significance. Â ’¢ conventional secondary surgery: 2 RCT that the survival of patients with advanced ovarian cancer after the first two conventional surgery is not better than the postoperative chemotherapy only control group. Cytotoxic chemotherapy of advanced ovarian cancer chemotherapy: Platinum + paclitaxel program: a systematic review and another RCT that advanced ovarian cancer after surgery, platinum + paclitaxel-based chemotherapy can extend the survival time and total Survival rate. ② platinum-containing chemotherapy program: a systematic review found that platinum-free platinum solution to any program can significantly improve the survival rate, especially the platinum treatment of the joint program. ③ carboplatin + paclitaxel and carboplatin + docetaxel comparison: no comparison of these two programs to find the efficacy of high-quality RCT. Comparison of platinum-containing regimens versus platinum-free regimens: Seven RCTs compared the two regimens; most RCTs found platinum-containing regimens to improve outcome with benefits and hazards depending on the specific regimen