卵巢正常大小的癌综合征55例临床病理分析

Clinicopathological analysis of 55 patients with normal-sized ovary carcinoma syndrome

目的探讨卵巢正常大小的癌综合征(NOCS)临床病理特征、存活率及预后影响因素,分析NOCS分子标志物的表达.方法对1992～2002年河北医科大学第四医院收治的55例NOCS患者进行回顾性分析,用免疫组化SP法检测CA125、Ber-EP4 、Calretinin和CK7在卵巢癌和NOCS中的表达.结果 NOCS占同期卵巢癌的6.56%,且近几年有上升趋势.NOCS患者初诊至手术的平均时间为(127.8±25.6)d,而卵巢癌患者的相应时间为(58.7±57.6)d,两者比较差异有显著性意义(t=2.01,P<0.05).阴道超声对NOCS的诊断准确率为93.5%.化疗≥3疗程、残留灶直径＜2cm者的平均生存时间与化疗＜3疗程、残留灶直径≥2cm者比较差异有显著性意义(P<0.05).患者术后平均生存时间与年龄、腹水量、临床分期、病理分级无关.NOCS的1年、3年、5年存活率分别为67.9%、29.1%、10.2%.CA125和Ber-EP4在卵巢原发癌中的表达高于卵巢外腹膜浆液性乳头状癌(EPSPC)中的表达(P<0.01, P<0.05),而在卵巢癌和卵巢原发癌中的表达差异无显著性意义.结论卵巢原发癌是NOCS的主要组成成分.50岁以上的中老年妇女出现不明原因的消化道症状、伴有大量腹水、妇科检查触不到肿块,应考虑到NOCS,及时行阴道彩色超声等检查及剖腹探查术.

Objective To summarize the clinicopathological features,survival rate and prognosis of 55 patients with normal-sized ovary carcinoma syndrome （NOCS） , and analyze the expressions of molecular markers of NOCS. Methods The clinicopathological features of 55 cases of NOCS in the Fourth Hospital of Hebei Medical University from 1992 to 2002 were analysed retrospectively. The survivors were followed up. By the immunohistochemistry, the archival formalinfixed, paraffin-embedded biological samples from these patients with NOCS were analyzed for the expressions of CA125,Calretinin,CK7 , and Ber-EP4.. Results NOCS accounted for approximately 6.56% of ordinary ovarian cancers. The incidence of NOCS has been increasing, it was 2.63% from 1992 to 1997, 9.56% from 1998 to 2002. The average time for NOCS patients from first time to hospital to being operated was （ 127.8±25.6）d,which was significantly higher than that of patients with ovarian carcinoma （58.7±57.6）d （P〈0.05）. Primary ovarian carcinoma was the major subtype of NOCS. Next subtype was EPSPC （extraovarian peritoneal serous papillary carcinoma） in NOCS. The ascites cytology and the vaginal sonography were very important tools for NOCS, and the accurate rates were 88.7% and 93.5% , respectively. The survival time of patients with chemotherapy more than 3 times and diameter of residual focus 〈2em was significantly longer than that of chemotherapy less than 3 times,and diameter ≥2cm （P〈0.05）. The survival time showed no relation to the patient g age,amount of ascites,clinical stage and the pathologic grade. The survival rates of 1 year,3 years and 5 years were 67.9% ,29.1% and 10.2% , respectively. The expression of CA125 and Ber-EP4 in primary ovarian cancer was higher than those of EPSPC （P〈0.01 ,P〈0.05 ） ,while it had no difference in ovarian carcinoma and primary ovarian cancer. Conclusion The patients with NOCS are a special group with a poor prognosis in gynecologic cancer unit. We should pay more attentions to patients more than 50 years old with digestive symptoms and ascites but no masses can be palpated. The ascites cytology and vaginal sonography are two useful diagnostic tools ;laparotomy can be performed if necessary.