脾切除术治疗卵巢上皮性癌脾转移32例临床分析

Splenectomy in epithelial ovarian cancer： analysis of 32 cases

目的探讨卵巢上皮性癌（卵巢癌）脾转移的临床病理特点，分析脾切除术作为卵巢癌肿瘤细胞减灭术的一部分的可行性及预后因素。方法采用回顾性研究方法，收集1998年1月至2006年6月在浙江省肿瘤医院行包括脾切除的肿瘤细胞减灭术的32例卵巢癌患者，对其临床病理及随访资料进行分析。结果浆液性腺癌为23例（72％），9例（28％）为非浆液性腺癌；病理分级：G1 0例，G211例（34％），G321例（66％）。术后20例无肉眼可见残余肿瘤，7例残余肿瘤直径≤2cm，5例残余肿瘤直径〉2cm。手术并发症发生率为25％（8／32），包括脾窝脓肿、腹壁切口感染、胃瘘、应激性胃溃疡、静脉血栓、不全肠梗阻等。中位随访时间为38个月（1～74个月），中位生存时间为50．9个月，2年、5年生存率分别为70％、36％。单因素分析显示病理分级、残余肿瘤有无、化疗疗程数影响预后（P均〈0．05）；多因素分析显示，仅残余肿瘤有无及化疗疗程数与预后有关（P均〈0．05）。结论卵巢癌脾转移最常见的病理类型为低分化浆液性腺癌。对于卵巢癌脾转移患者，脾切除术作为肿瘤细胞减灭术的一部分是安全、有效的治疗方法；术后残余肿瘤有无、化疗疗程数是独立的预后因素。

Objective To investigate the clinicopathologic features, the complications of splenectomy and the survival of epithelial ovarian cancer patients with splenic metastasis. Methods A retrospective study was performed of 32 patients with epithelial ovarian cancer who underwent splenectomy for tumor cytoreduction at Zhejiang Cancer Hospital between Jan 1998 and Jun 2006. Results Of 32 patients, 23 patients （72%） were serous adenocarcinoma and 9 were non-serous adenocarcinoma. According to pathological grade, none was of G1 , 11 were of G2, 21 were of G3. Postoperatively, 20 patients were left with no residual tumor, 7 were with ≤ 2 cm and 5 were with 〉 2 cm residual tumor. Postoperative complications developed in 8 patients （25%）, including subphrenic abscess, wound infection, gastric perforation, gastrorrhagia, phlebothrombosis, and bowel obstruction. The median follow up was 38 months, estimated 2-year and 5-year overall survival were 70% and 36%. Univariate analysis revealed that histological grade, residual tumor and courses of chemotherapy were influencing factors of the survival （P 〈 0.05 ）, but multivariate analysis indicated that only residual tumor and courses of chemotherapy independently influenced survival （ P 〈 0. 05 ）. Conclusions In epithelial ovarian cancer patients with splenic metastasis, low grade serous adenocarcinoma is most common. Splenectomy as part of cytoreductive surgery is associated with modest morbidity and mortality. Residual tumor and courses of chemotherapy are independent factors associated with the prognosis of the patients.