摘要
目的 探讨全面分期手术或再分期手术时发现的Ⅰ期卵巢透明细胞癌患者微转移(隐匿转移病灶)病灶的发生情况及影响预后的高危因素。方法 回顾性分析2015年2月至2019年12月北京协和医院收治的卵巢透明细胞癌患者160例,其中手术时病变局限于卵巢者91例,记录患者年龄、手术方式、术中所见、再次分期手术方式、国际妇产科联盟(FIGO)分期、病理结果及随访信息。根据初次治疗手术方式将患者分为两组,全面分期手术组为初次治疗行全面分期手术;再分期手术组为初次治疗未行分期术或分期不全行再分期手术。Kaplan-Meier绘制生存曲线、计算并比较患者生存期及无进展生存期,预后分析采用Cox风险回归模型。结果 91例患者初次手术探查时为临床Ⅰ期,中位年龄49(22~71)岁,肿瘤直径(10.6±4.6)cm,术前糖类抗原125(CA125)升高者35例(38.5%)。初次手术行全面分期者51例(56.0%),未行分期术或分期不全行再分期手术者40例(44.0%)。全面分期手术及再分期手术后经病理证实转移率为15.4%(14/91)。FIGO分期提高者14例(15.4%),其中提高为Ⅱ期者6例(6.6%),Ⅲ期8例(8.8%)。术后行以铂类为基础化疗85例(93.4%),未行化疗6例(6.6%)。随访时间(49.5±19.5)个月,复发率为19.8%(18/91),病死率为8.8%(8/91)。全面分期手术组及再分期手术组FIGO分期提高为Ⅱ~Ⅲ期者分别占17.6%(9/51)和12.5%(5/40),淋巴结转移率分别为7.8%(4/51)、7.5%(3/40),差异均无统计学意义(P>0.05)。全面分期手术组及再分期手术组患者的5年无进展生存率分别为74.2%、92.0%(P=0.063)。两组患者5年总生存率分别为86.0%、90.7%(P=0.676)。单因素分析显示FIGO分期(Ⅲ期相对Ⅰ、Ⅱ期)对无进展生存期的影响具有统计学意义(HR=4.158,95%CI 1.334~12.963,P=0.014),而再分期手术相对全面分期手术,对无进展生存期(HR=0.361,95%CI 0.117~1.109,P=0.075)及总生存期(HR=1.349,95%CI 0.337~5.401,P=0.672)的影响无统计学意义。多因素分析结果提示,FIGO分期Ⅲ期相对Ⅰ、Ⅱ期患者,对无进展生存期的影响具有统计学意义(HR=5.570,95%CI 1.196~25.940,P=0.029)。结论 Ⅰ期卵巢透明细胞癌患者分期提高率及淋巴结转移率并不低,且分期提高仍为影响预后的独立高危因素,应提高初次手术对可疑早期卵巢透明细胞癌的诊断率,减少手术分期不全及再分期手术率。
Objective To explore the occurrence and high-risk factors affecting prognosis of micro-metastasis(occult metastatic lesions)in stage I ovarian clear cell carcinoma patients during comprehensive staging surgery or restaging surgery.Methods A retrospective analysis was performed on 160 patients with ovarian clear cell carcinoma admited to Peking Union Medical College Hospital from February 2015 to December 2019,including 91 patients with lesions confined to the ovary at the time of surgery.Patients'age,surgical procedure,intraoperative findings,restaging surgery procedure,FICO stage,pathological results and follow-up information were recorded in detail.Patients were divided into two groups based on the initial treatment approach:the comprehensive staging surgery group,who underwent comprehensive staging surgery at the initial treatment,and the restaging surgery group,who either did not undergo staging surgery or underwent incomplete staging at the initial treatment and subsequently underwent restaging surgery.Kaplan-Meier was used to plot survival curve and calculate and compare patients'overall survival and progression-free survival.COX risk regression model was used for prognostic analysis.Results The 91 patients was considered as clinical stage I with a median age of 49 years(22-71 years)and a mean tumor size of(10.6±4.6)cm at the time of initial surgical exploration.The level of preoperative CA125 increased in 35 patients(38.5%).Totlly 51 cases(56.0%)underwent comprehensive staging in the primary surgery,and 40 cases(44.0%)underwent restaging surgery.The confirmed metastasis rate after comprehensive staging surgery and restaging surgery was 15.4%(14/91).FIGO stage was upgraded in 14 patients(15.4%),including 6 patients(6.6%)was upgraded to stage II and 8 patients(8.8%)to stage II.After operation,85 patients(93.4%)received platinum-based chemotherapy,and 6 patients(6.6%)did not receive chemotherapy.The mean follow-up time was(49.5±19.5)months,the recurrence rate was 19.8%,and the mortality rate was 8.8%.FICO stage was upgraded to II-II in 17.6%(9/51)of the patients in the comprehensive staging group and 12.5%(5/40)in restaging group.The lymph node metastasis rate of the two groups was 7.8%(4/51)and 7.5%(3/40),respectively,the diference being with no statistical significance(P>0.05).The 5-year progression-free survival rate of patients in the comprehensive staging group and the restaging group was 74.2%and 92.0%,respectively(P=0.063).The 5-year overall survival rate of the two groups was 86.0%and 90.7%,respectively(P=0.676).Univariate analysis showed that FIGO stage(II compared to I,I)had a statistically significant effect on progression-free survival(HR=4.158,95%CI 1.334-12.963,P=0.014),while restaging surgery,compared to comprehensive staging surgery,had no statistical effect on progression-free survival(HR=0.361,95%CI 0.117-1.109,P=0.075)and overall survival(HR=1.349,95%CI 0.337-5.401,P=0.672).Multivariate analysis showed that FIGO stage II had a statistically significant effect on PFS compared with stage I and II(HR=5.570,95%CI 1.196-25.940,P=0.029).Conclusions The rates of upgrading of stage and lymph node metastasis of stage I ovarian clear cell carcinoma are not low,and the upgrading of tumor stage is still an independent risk factor affecting prognosis.Therefore,the diagnosis rate of suspected early clear cell carcinoma of ovary should be increased in the initial operation,and the rate of incomplete surgical staging and restaging should be reduced.
作者
刘倩
周慧梅
杨佳欣
曹冬焱
向阳
沈铿
LIU Qian;ZHOU Hui-mei;YANG Jia-xin;CAO Dong-yan;XIANG Yang;SHEN Keng(Department of Obstetrics and Gynecology,Peking Union Medical College Hospital,Peking Union Medical College,Chinese Academy of Medical Sciences,National Clinical Research Center for Obstetric&Gynecologic Diseases,Beijing 100730,China)
出处
《中国实用妇科与产科杂志》
北大核心
2025年第6期653-657,共5页
Chinese Journal of Practical Gynecology and Obstetrics
基金
国家重点研发计划(2022YFC2704400)。
关键词
卵巢透明细胞癌
全面分期手术
再次分期手术
化疗
clear cell carcinoma of ovary
comprehensive staging surgery
restaging surgery
chemotherapy
