原发性输卵管癌40例临床分析

Primary Fallopian Tube Carcinoma: A Retrospective Clinical Analysis of 40 Patients

目的:探讨原发性输卵管癌临床特点及影响预后的相关因素。方法:回顾性分析40例原发性输卵管癌患者的临床资料,采用Kaplan-Meier生存曲线、Cox单因素和多因素分析方法,对原发性输卵管癌预后因素进行分析。结果:患者中位年龄51岁,均接受手术治疗;29例(72.5%)诊断为Ⅰ期或Ⅱ期,11例为Ⅲ期或Ⅳ期;32例(80.0%)病理分级为低分化,22例(55.0%)为浆液性腺癌。37例患者术后分别接受了PAC/PC或TC方案化疗。6例患者在术后23～56个月复发。Ⅰ～Ⅱ期与Ⅲ～Ⅳ期中位生存时间分别为79个月和35个月,5年生存率分别为58.0%和0(P=0.005)。经单因素和多因素分析发现FIGO分期(Ⅰ～Ⅱ期与Ⅲ～Ⅳ期)、病理分级(G_1+G_2级与G_3级)、术后残留灶(无肉眼残留灶、残留灶<1cm与>1cm)均是影响该病预后的独立因素。依据公式计算CA125半衰期,比较术后3周时血CA125较术前下降情况(T_(1/2)>3周组、T_(1/2)<3周组),5年生存率分别为78.0%和50.0%(P=0.036)。结论:临床工作中须重视原发性输卵管癌术前各项辅助检查的联合筛查作用,进行全面的鉴别诊断避免误诊,连续动态监测血清CA125水平对评估预后有重要作用。

Objective： To investigate the clinical features and survival factors of primary fallopian tube carcinoma. Methods： We used Kaplan-Meier survival analysis, single factor analysis and multivariate analysis to evaluate the prognostic factors of 40 patients diagnosed with primary fallopian tube cancer. Results： The average age of the patients was 51 years and all of them received surgery. There were 29 （72.5%） stage Ⅰ or Ⅱ patients, 11stage Ⅲ or Ⅳ patients. Thirty-one （77.5%） patients were diagnosed with poorly differentiated tumors and 22 （55%） patients had serous adenocarcinoma. Thirty-seven patients received PAC/PC or TC chemotherapy after surgery. Six patients （15%） had recurrences within 23 to 56 months after surgery. The median survival of Ⅰ-Ⅱ and Ⅲ-Ⅳ stage patients was 79 and 35 months, respectively. The total 5-year survival was 58% and 0 （P=0.005）. Univariate and multivariate analysis showed that stage （ Ⅰ-Ⅱ vs. Ⅲ-Ⅳ）, grade （G1＋G2 vs. G3）, residual disease after surgery （none, 〈1cm vs. 〉1cm） were significant factors affecting survival. In accordance with the formula to calculate the half-life of CA125 and compare preoperative serum CA125 with the value at 3 weeks after surgery （T1/2〉3 week, T1/2〈3 week）, the 5-year survival was 78% and 50%, respectively （P=0.036）. Conclusion： Special attention should be paid to the joint screening of primary fallopian tube cancer in clinical practice in order to avoid misdiagnosis. The consecutive measurements of serum CA-125 level may have significant value as a prognostic indicator for patient survival.