卵巢交界性黏液性肿瘤130例临床病理分析

Clinicopathologic analysis of 130 cases of mucinous borderline ovarian tumors

目的 探讨卵巢交界性黏液性肿瘤的临床病理特征及复发相关危险因素.方法 选择1994年1月至2008年12月北京协和医院收治的卵巢黏液性交界性肿瘤患者130例,回顾性分析其临床病理特征,包括年龄、术前血清肿瘤标志物（术前有血清CA125、CA199检测资料的患者分别为96、26例）、手术方式、病理特点、手术病理分期及复发情况,并对复发相关因素进行分析.结果 患者平均发病年龄为41岁（14～85岁）,分别有34%（33/96）和50%（13/26）的患者术前血清CA125或CA199水平升高.手术方式：广泛性手术（即不保留生育功能的手术）52例（40.0%）,保守性手术（即保留生育功能的手术）78例（60.0%）,其中54例（41.5%）行单侧附件切除术、24例（18.5%）行患侧肿瘤剔除术;共55例患者进行了全面分期手术,其中保守性手术和广泛性手术分别为27和28例.病理特点：肿瘤平均直径（16±10）cm（4～50 cm）,117例（90.0%）患者的肿瘤位于单侧;45例（34.6%）伴良性黏液性肿瘤,14例（10.8%）伴上皮内癌,8例（6.2%）伴间质微浸润癌,4例（3.1%）伴腹膜假黏液瘤.手术病理分期：Ⅰa期59例（45.4%）,Ⅰc期62例（47.7%）,Ⅱ期2例（1.5%）,Ⅲ期7例（5.4%）.复发情况：平均随访56.3个月（6～198个月）,16例（12.3%）复发,手术至初次复发平均间隔时间为25.6个月（6～62个月）,2例为肿瘤相关性死亡.复发相关因素：广泛性手术及保守性手术包括患侧附件切除、患侧卵巢肿瘤剔除术后的复发率分别为4%（2/49）、13%（7/54）和17%（4/24）,广泛性手术后的复发率明显低于保守性手术（P＜0.05）;Ⅰa、Ⅰc和Ⅲ期患者的复发率分别为3%（2/59）、18%（11/62）和3/7,Ⅰc和Ⅲ期患者的复发率均明显高于Ⅰa期（P＜0.05）;伴腹膜黏液瘤患者的复发率为3/4,明显高于其他交界性肿瘤（P＜0.01）,而是否伴上皮内癌、间质微浸润癌及行全面分期手术均与复发无关（P＞0.05）.结论 卵巢黏液性交界性肿瘤可能为卵巢黏液性癌的癌前病变,但发病年龄轻、期别早、预后好.保守性手术较广泛性手术易复发,但并不影响远期生存;是否伴上皮内癌、间质微浸润癌及行全面分期手术与复发无关;而期别晚、合并腹膜假黏液瘤与复发相关.

：Objective To determine the clinicopathologic characteristics of mucinous borderline ovarian tumors （MBOT） and evaluate the risk factors for recurrence. Methods A retrospective study included age, the level of Preoperative serum CA125, surgical procedures, surgical-staging and the risk factors for recurrence in 130 patients with MBOT who were treated from Jan. 1994 to Dec. 2008 in Peking Union Medical College Hospital was done. Results Preoperative serum CA125 and CA199 were elevated in 34% （33/96） and 50% （13/26） of patients respectively. Fifty-two radical surgeries included total hysterectomy and bilateral saipingo-oovarectomy （THBSO） and 78 fertility-sparing surgeries included 54salpingo-oovarectomies （SO） and 24 cystectomy were done. Fifty-five cases underwent comprehensive surgical staging. Mean size of the tumors was （16 ± 10）cm and 90. 0% （117/130） were limited to unilateral ovary. There were 59 （45.4%） cases, 62 （47.7%o） cases, 2 （1.5%） cases and 7 （5.4%） cases in stage Ⅰa, Ⅰc, Ⅱ , Ⅲ , respectively. Forty-five（34.6%）concurrent with benign mucinous tumors, 14（10.8%）ovarian intraepithelial carcinoma, 8 （6.2%） micro-invasive carcinoma and 4 （3.1%） pseudomyxoma peritonei were found. Median duration for follow-up was 56.3 months. Sixteen （12.3%） recurrences and 2 tumor related deaths were found. Median duration from surgery to recurrence was 25.6 months. Recurrent rate after THBSO（4%, 2/49）was significantly lower than that of SO（13%, 7/54） and cystectomy （17%,4/24; P 〈 0.05）. The recurrent rate of Ⅰc or Ⅲ was 18% （11/62） or 3/7, which were significantly higher than that of stage Ⅰa （3% ,2/59; P 〈0.05）. Three of the 4 pseudomyxoma peritonei appeared recurrence.While,the results showed that these were no effect on recurrent rate whether concurrent intraepithelial,microinvasive carcinoma or not comprehensive staging surgery. Conclusions Majority of MBOT were diagnosed in early stage and have favorable prognosis. Patients who take conservative surgery had higher recurrence rate than those radical surgery, but it doesn＇t affect survival. Late stage and concurrent pseudomyxoma peritonei are risk factors for recurrence.