卵巢癌肉瘤12例临床分析

Clinical analysis of 12 cases of ovarian carcinosarcoma

目的探讨卵巢癌肉瘤的临床特征、治疗方法及预后。方法收集中山大学肿瘤防治中心2002年5月至2009年5月收治的12例卵巢癌肉瘤的临床资料进行回顾性分析。结果 12例患者诊断时中位年龄55岁,其中10例为绝经后患者。患者就诊时主要临床症状为腹痛、腹胀、腹水等。10例入院时血CA125升高,7例术后化疗后降至正常,8例病情复发时伴CA125升高。影像学检查均发现盆腔包块。确诊依靠术后病理。所有患者均接受手术治疗及术后以铂类为基础的联合化疗,2例术后无瘤生存;10例术后2年内复发,其中2例经再次治疗后缓解生存,1例正接受化疗,5例死亡,2例失访。结论卵巢癌肉瘤预后差,手术及术后以铂类为基础的联合化疗是卵巢癌肉瘤的主要治疗方法,预后与减瘤术后残存病灶大小有关,复发性卵巢癌肉瘤患者经积极治疗后仍有可能获得缓解,血清CA125可作为观察化疗疗效的标志物,并用于治疗后的监测随访。

Objective To evaluate the clinicalpathological characteristics,treatment and prognosis of ovarian carcinosarcorma.Methods The clinical,pathological and follow-up data of 12 cases of ovarian carcinosarcoma treated in Cancer Center of Sun Yat-sen University from May,2002 to May,2009 were analyzed retrospectively.Results The 12 patients with ovarian carcinosarcoma had a median age of 55 years at diagnosis,among whom 10 were postmenopausal women.The patients sought medical attention for such symptoms as pelvic and/or abdominal pain,abdominal distention and ascites.Ten patients showed elevated serum CA125 level ad admission,and postoperative chemotherapy resulted in lowered CA125 level within normal range in 7 of them;in 8 cases,CA125 level increased with disease recurrence.Pelvic mass was found by such imaging examinations as CT,MRI and ultrasound in all cases.A definite diagnosis was obtained by postoperative pathological examination.All the patients received surgical resection and platinum-based adjuvant chemotherapy.Two patients achieved disease-free survival after the treatment.Disease relapse occurred in 10 cases within 2 years after surgery,among whom 2 showed disease remission after a secondary surgery and/or chemotherapy,and 1 was receiving chemotherapy;death occurred in 5 cases,and 2 cases were lost to the follow-up.Conclusions Ovarian carcinosarcoma has a poor prognosis.Primary surgery and platinum-based postoperative adjuvant chemotherapy is the main treatment for ovarian carcinosarcoma.The prognosis of ovarian carcinosarcoma is associated with the residual disease after surgery.The patients with disease recurrence may obtain remission and survival through a secondary surgery and/or chemotherapy.Serum CA125 can be used as a marker for monitoring the chemotherapeutic effect in clinical observation and follow-up visits.