卵巢上皮性癌合并卵巢子宫内膜异位症67例临床病理分析

Clinicopathological features of 67 cases of endometriosis-associated epithelial ovarian carcinoma

目的探讨合并卵巢子宫内膜异位症（内异症）的卵巢上皮性癌（卵巢癌）的临床病理特点。方法选取1996年1月至2006年12月在复旦大学附属妇产科医院就诊并经手术确诊的卵巢癌共727例，对其中合并卵巢内异症的67例患者（其中由卵巢内异症恶变的卵巢癌患者34例，为A组；其他仅合并卵巢内异症的卵巢癌患者33例，为B组）的临床病理资料进行回顾性分析，并与660例未合并卵巢内异症的卵巢癌患者（C组）进行对照分析。同期本院经手术病理确诊的卵巢内异症患者共3890例。结果卵巢内异症恶变为卵巢癌的发生率为0．87％（34／3890）。卵巢癌合并卵巢内异症的发生率为9．2％（67／727）。A、B、C组患者的平均年龄分别为（47．2±1．3）、（47．8±1．2）、（51．2±0．4）岁，3组间比较，差异有统计学意义（P=0．013）。A、B组病理类型多为透明细胞癌（分别为67．6％、69．7％），其所占比例均明显高于C组的18．8％（P=0．000）；而C组以浆液性腺癌（50．3％）为主，其所占比例明显高于A组的8．8％和B组的12．1％（P=0．000）。A、B组手术病理分期多为I期（分别为73．5％、63．6％），其所占比例均明显高于C组的31．4％（P=0．000）；而C组多为Ⅲ期（47．7％），其所占比例明显高于A组的23．5％和B组的15．2％（P=0．001）。A、B、C组高分化（分别为11．8％、6．1％、10．5％）、中～低分化（分别为88．2％、93．9％、89．5％）所占比例分别比较，差异均无统计学意义（P=0．602）。A、B、C组雌激素受体（ER）阳性率分别为22．2％（6／27）、31．6％（6／19）、43．9％（136／310），3组间比较，差异有统计学意义（P=0．018）；A、B、C组孕激素受体（PR）阳性率分别为22．2％（6／27）、15．8％（3／19）、35．5％（110／310），3组间比较，差异无统计学意义（P=0．082）。患者总的5年累积生存率为55．6％，A、B、C组患者的5年累积生存率分别为78．9％、92．8％、51．9％，3组间比较，差异有统计学意义（P=0．000）。结论合并卵巢内异症的卵巢癌患者，具有年轻（尤其是内异症恶变患者）、多为卵巢透明细胞癌、期别早、ER表达水平低、预后好的特点。

Objective To investigate clinicopathological features of endometriosis-associated epithelial ovarian carcinoma. Methods Retrospective follow-up study, clinicopathological data from patients with ovarian epithelial carcinoma were retrieved, analyzed and compared. Among the 727 cases, 34 were found to originate from endometriosis （group A ）, 33 were found to have co-existing ovarian endometriosis （group B）, and the remaining 660 had no ovarian endometriosis at all （group C）. Result Seven hundred and twenty-seven epithelial ovarian carcinoma patients were identified and their clinicopathological data retrieved. Sixty-seven （9. 2% ） of these cases were found to have coexisting endometriosis. The frequency of malignant tumors arising from ovarian endometriosis in this case series was estimated to be 0. 87% （34/3890） . The mean （standard deviation） age in groups A, B, and C were（47. 2 ± 1.3）, （47. 8±1.2）, （51.2 ± 0. 4） years, respectively, with patients in group C being significantly older （ P = 0. 013 ）. Patients with coexisting ovarian endometriosis were mostly diagnosed at stage Ⅰ （ P = 0. 000） and having subtype of clear-cell （P = 0. 000）, while other patients were mostly diagnosed at stage Ⅲ （P = 0. 001 ） , and having subtype of serous carcinoma （P =0. 000）. The estrogen receptor （ER） positivity was significantly lower in groups A and B than that in group C （22. 2% , 31.6% vs 43.9% ; P =0. 018）, but the difference in positivity of progestogen receptor among the three groups did not reach statistical significance （22. 2% , 15.8% vs 35.5% ; P = 0. 082）. While the five-year overall survival rate for all patients was 55.6% , significant difference in overall survival among the three groups was found 78.9%, 92. 8%, 51.9% , respectively, for groups A, B and C （P = 0.000） . Conclusion Patients of endometriosis-associated epithelial ovarian carcinoma, especially patients with tumors arising from endometriosis, were found to be younger, having a significant lower stage and a better survival, and were mostly diagnosed with the subtype of clear-cell.