88例卵巢透明细胞癌临床及预后分析

Prognostic analysis of 88 patients with ovarian clear cell carcinoma

目的分析卵巢透明细胞癌的临床病理特点,探讨更有效的治疗方法和影响预后的因素。方法回顾性分析1984年1月至2005年5月收治的88例卵巢透明细胞癌患者的临床及随访资料。结果(1)43例患者术后给予以铂类为主的联合化疗,有效率为35.0%,复发率为67.4%,3、5年生存率分别为43.9%和29.3%;33例患者给予紫杉醇(PTX)联合铂类化疗,有效率为73.9%,复发率为45.5%,3、5年生存率分别为57.3%和40.5%;12例患者给予开普拓(CPT-11)+丝裂霉素(MMC)联合化疗,有效率为71.4%,复发率为25.0%,3年生存率为70.7%。(2)88例患者中,复发47例,复发率为53.4%。Ⅰ期患者总的复发率(45.4%)明显低于Ⅱ+Ⅲ期患者(75.0%);Ⅰ期行淋巴结清扫术患者的复发率(27.8%)明显低于未行淋巴结清扫术者(51.3%);CA125升高患者的复发率(67.3%)明显高于CA125正常或不详者(38.1%)。(3)88例患者总的3、5年生存率分别为48.7%和40.9%。Ⅰ期患者总的3、5年生存率明显高于Ⅱ+Ⅲ期患者(P<0.05);Ⅰ期行淋巴结清扫术患者的3、5年生存率明显高于未行淋巴结清扫术者(P<0.05);Ⅲ期术后残存肿瘤<2cm患者的3、5年生存率明显高于残存肿瘤≥2 cm的患者(P<0.05);CA125升高患者的3、5年生存率与CA125正常或不详者的差异无统计学意义(P>0.05)。结论卵巢透明细胞癌的预后较差,对以铂类为主的联合化疗可能更耐药;临床分期、是否行淋巴结清扫术以及化疗方案的选择等因素可能会影响预后。

Objective To investigate the clinical characteristics of clear cell carcinoma of the ovary and to compare the survival of the patients treated by three different chemotherapy regimens. Methods Between 1984 and 2005, the clinical data of 88 surgically treated patients with clear cell carcinoma of the ovary were retrospectively analyzed. Of the 88 patients, 55 （62.5%） had tumor in stage Ⅰ , 2 in stage Ⅱ ,22 in stage Ⅲ ,3 in stage IV and 6 in indefinite stage. These patients underwent either bilateral salpingo-oophorectomy with hysterectomy and omemtectomy or cytoreduction surgery. Of 55 stage I patients, 20 received pelvic lymohadenectomy. All patients were given postoperative chemotherapy, 43 patients received CAP/CP, 33 paclitaxel combination with carboplatinum/cisplatin （TC/TP） and 12 CPT-11 plus MMC. Results The response rate, recurrence rate, 3- and 5-year survival was 35.0% , 30.2% （13/43） , 67.4% （29/43） , 43.9% and 29.3%, respectively in patients treated with CAP/CP; 73.9%, 18. 2% （6/33）, 45.5% （ 15/33）, 57.3% and 40.5%, respectively in the patients with TC/TP; 71.4%, 16.7% （2/12）, 25.0% （3/12）, 70.7% （ 3-yr survival, no available 5-yr survival）, respectively in the patients with CPT-11 ＋ MMC （P 〈 0.05）. During follow-up, 47（53.4% ） patients were found to have recurrence, it was 45.4% （25/55） in stage I patients including 29. 6% （ 8/27 ） in stage I a＋ I b and 60.7%（17/28） in stage I c, 75.0% （18/24） in stage Ⅱ ＋ Ⅲ and 4/6 in the indefinite FIGO stage. The recurrences rate was 27.8% （5/18） in stage I patients with pelvic lymphadenectomy vs. 51.3% （19/37） in those without. It was 67.3% in 46 patients with elevated CA125, and 38.1% in the other 42 patients with normal or unavailable CA125 （P 〈 0.05 ）. The overall3- and 5-year survival rate of 88 patients was 48.7% and 40.9%, respectively, with 72.5% and 66.8% in stageI, 100.0% and 70.5% in stage Ⅰa ＋ Ⅰb, 68.5% and 60. 3% in stage Ic, 41.8% and 20. 8% in stageⅡ＋ Ⅲ, 0 in stage IV （P 〈0.05）. The 3- and 5-year survival in stage I with pelvic lymphadenectomy was 88.5% and 75.8% vs. 70.3% and 65.1% in those without （P 〈0. 05）. The 3- and 5-year survival of the patients with optimal （ residual disease less than 2 cm） was 36.7% and 23.1% vs. 22.2% and 0 in those with suboptimal cytoreduction （ P 〈 0.05 ）, it was 46. 8% and 38.8% in the patients with elevated CA125 vs. 46. 7% and 43.5% in those with normal one （P 〉 0.05）. Conclusion Our data show that ovarian clear cell cancer patient have a poor response to CAP/CP and may have a better response to TC/TP, especially to CPT-1 1 plus MMC. However, the overall prognosis is still poor and further clinical investigations are needed to improve it.