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Preživetje bolnic z rakom jajcnikov
Avtor: Vesna Zadnik
Mentor: doc. dr. Maja Primic Žakelj, dr. med
V retrospektivni študiji smo analizirali podatke o 282 bolnicah, ki so bile med 1990 in 1992 primarno zdravljene zaradi epitelijskega ovarijskega malignoma na Onkološkem inštitutu in Ginekološki kliniki v Ljubljani. Vse smo sledili do leta 1997. Enaindvajset bolnic v vzorcu je imelo mejno maligen tumor, 259 pa karcinom.
S Kaplan-Meierjevo metodo smo izracunali skupno preživetje za obe skupini in posamezna preživetja glede na razlicne napovedne dejavnike pri karcinomih. Z logrank testom smo preverjali, ce posamezni napovedni dejavniki statisticno znacilno vplivajo na preživetje. Z univariatno analizo po Coxu smo izracunali relativna tveganja za smrt pri posameznih napovednih dejavnikih. S Coxovo multivariatno analizo pa smo te napovedne dejavnike prilagodili med seboj.
Petletno preživetje pri mejno malignih tumorjih je 74 %, pri karcinomih 38 %. Bolnice s karcinomom umirajo 3-krat pogosteje od tistih z mejno malignimi tumorji. Petletna preživetja po stadijih (1-4) so: 88 %, 48 %, 26 % in 12 %. Bolnice za rakom jajcnikov v stadiju 4 umirajo 21-krat pogosteje od tistih v stadiju 1. Zaradi raka na jajcnikih umre vec starejših bolnic kot mlajših (starejše od 70 let 5-krat pogosteje kot mlajše od 40 let). Petletno preživetje mlajših je 65 %, starejših pa 12 %. Bolnice v vzorcu smo razdelili tudi na starejše in mlajše od 50 let. Verjetnost za smrt pri starejših je 2,5-krat vecja kot pri mlajših. Njihovo petletno preživetje je 31 %, mlajših pa 61 %. Glede na stopnjo diferenciacije (1-3) so petletna preživetja naslednja: 69 %, 49 %, 26 %. Bolnice s stopnjo diferenciacije 3 umirajo 3-krat pogosteje od tistih s stopnjo diferenciacije 1. Ce je bil ostanek po prvi operaciji vecji od 1 cm, so bolnice umirale 5-krat pogosteje, kot ce ostanek ni bil makroskopsko viden. Preživetje prve skupine je 18 %, druge pa 73 %.
Ce prilagodimo napovedne dejavnike med seboj, imajo pri analiziranju celega vzorca še vedno znacilen vpliv: stadij, starost nad 50 let, vrsta primarnega zdravljenja in velikost ostanka vec kot 1 cm po operaciji. Isto velja za skupino, ki je imela višje stadije (3 in 4). Za skupino z nižjimi stadiji (1 in 2) pa vrsta primarnega zdravljenja nima znacilnega pomena.
Poznavanje vpliva napovednih dejavnikov na preživetje z epitelijskim rakom jajcnika omogoca pregled nad stanjem pri nas in primerjavo z drugimi centri po svetu.
[Abstract / English version]
Survival of patients with ovarian cancer
Author: Vesna Zadnik
Mentor: doc. dr. Maja Primic Žakelj, dr. med
Data from 282 patients who were first treated for epithelial ovarian malignoma at the Institute of Oncology and Gynecological clinic in Ljubljana between 1990 and 1992 were analysed retrospectively. Twenty-one patients had borderline tumours and 259 had malignant ones. The patients were followed through 1997.
The survival rates for malignant and borderline tumours were established and the influence of different prognostic factors on the survival of ovarian cancer patients was evaluated. The statistical method used was the Kaplan-Meier method. The statistical significance of individual prognostic factors was examined using the logrank test. The hazard ratio for each prognostic factor was established using Cox univariat analysis. The adjusted hazard ratios were calculated using Cox multivariat analysis for all prognostic factors.
The five-year survival rate was 74% for borderline patients and 38% for patients with carcinomas. The carcinoma patients died three-times more often than the borderline tumour patients. The five-year survival rates by stage (1-4) were as follows: 88%, 48%, 26% and 12%. The probability of dying with stage 4 was 21-times greater than stage 1. Older patient die more frequently than younger ones (those older than 70 are five-times more likely to die than those younger than 40). Five-year survival rates for the older group were 12% and for the younger group 65%. Those older than 50 died 2.5-times more often than those younger than 50. The five-year survival rate of those older than 50 is 31% compared with 61% in those younger than 50. In terms of cancer grades (1-3), the five-year survival rates are: 69%, 49%, 26%, respectively. Patients with grade three died three-times more frequently then those with grade 1. The group with the diameter of residual implants after first surgery greater then 1 cm died five-times more often then the group with no macroscopic residual disease. The five-year survival of the first group is 18% and of the second group is 73%
After multivariate analysis the prognostic factors which were still significant are: stage, age higher then 50, the diameter of residual implants after first surgery greater than 1 cm, and type of primary treatment for the whole cohort. The same was valid for the group in the higher stages (3 and 4) of cancer. The type of primary treatment was not significant for the group with the lower stages (1 and 2) of cancer.
An understanding of the influence of these prognostic factors on the survival rate in epithelial ovarian malignoma offers the opportunity to survey the situation in Slovenia and to compare our cohort with those in cancer centers throughout the world.