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664例上皮性卵巢癌的临床病理分析

Pathological Characteristics and Prognosis of 664 Patients with Epithelial Ovarian Cancer: a Retrospective Analysis

  • 摘要: 目的 探讨上皮性卵巢癌(EOC)患者临床病理特点,并对影响预后的高危因素进行分析。方法 回顾性分析2006年1月至2011年6月间在我院接受手术治疗的710例EOC患者的临床资料,对其临床病理特点进行总结,单因素及多因素分析影响预后的高危因素。结果 将664例资料完整的EOC患者纳入研究。患者年龄(49.35±11.58)岁(15~84岁),其中40岁以上患者占79.07%(525/664);术前550例患者进行了CA125检测,其中升高者占82.55%(454/550);浆液性癌占55.57%,黏液性癌占7.68%,子宫内膜样癌占10.09%,透明细胞癌占12.35%;组织分化为G2~G3者占89.61%;FIGO Ⅰ期占30.72%,Ⅱ~Ⅳ期占69.28%;有483例患者接受了腹膜后淋巴结切除术,其中淋巴结转移者占32.71%。平均随访(37.48±12.51)月,664例患者中有126例复发,复发平均时间(26.10±5.75)月;303例死亡,占46.08%,平均存活时间(28.54±9.56)月,其中287例为癌症相关性死亡;存活的361例患者中,无瘤生存者占81.72%,带瘤生存者占18.28%。单因素分析显示EOC患者的预后与发病年龄、FIGO分期、淋巴结转移、缩瘤满意程度、术前CA125水平、病理类型、组织分化及发病模式等因素均有关(P均=0.000);将患者年龄、FIGO分期、缩瘤满意程度、病理类型、组织分化、发病模式等因素进行多因素分析,结果显示除组织分化以外,其余5项均与患者预后有关;术前CA125升高患者缩瘤满意程度差于CA125正常者(P=0.001)。Log-rank分析显示FIGO分期晚、高级别组织分化、缩瘤不满意、淋巴结有转移以及Ⅱ型卵巢癌等均对生存情况有不良影响。结论 EOC患者发病年龄大、发现时多为晚期,预后差。患者年龄、FIGO分期、缩瘤满意程度、病理类型与患者预后有关。

     

    Abstract: Objective To analyze clinicopathologic features and risk factors associated with the recurrence and prognosis of epithelial ovarian cancer (EOC). Methods 710 EOC patients treated at the West China University Second Hospital from Jan. 2006 to Jun. 2011 were recruited in this study retrospectively. Univariate and multivariate logistic regression models were constructed to evaluate the risk of factors. Kaplan-Meier and log-rank methods were adopted for survival analyses. Results The final sample included 664 patients with complete and well-documented data. The participants had a mean age of (49.35±11.58) yr. and 79.07% (525/664) were older than 40 year-old. CA125 was tested in 550 patients before surgery and 82.55% showed abnormal values. Over half (55.57%) of the patients were classified as serious EOC, which was followed by clear cell EOC (12.35%), endometrioid EOC (10.09%), mucinous EOC (7.68%), and others (14.31%). StageⅠ(FIGO) comprised 30.72% of the cases. The patients were followed up on average of (37.48±12.51) months and 303 died with a mean survival length of (28.54±9.56) months. Recurrence was found in 126 patients at a median of (26.10±5.75) months. For the 361 survived, 81.72% lived without detectable cancer. All patients received surgical operations, including 483 undergoing retroperitoneal lymphadenectomy. The univariate analysis identified older age, advanced FIGO stage, suboptimal debulking, abnormal CA125 values before surgery, undifferentiated, mixed type and serous pathologic subtypes, poor-differentiation and pathogenesis of tumor as risk factors associated with survival prospect. The multivariate logistic regression models confirmed that poor prognosis was associated with older age, advanced FIGO stage, suboptimal debulking and undifferentiated, mixed type and serous pathologic subtype. Conclusion Older age, advanced FIGO stage, high grade differentiation, suboptimal debulking, lymph-node metastasis, and type Ⅱ EOC are associated with poor prognosis of EOC patients.

     

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