卵巢上皮性癌脑转移13例临床分析

Brain metastases from epithelial ovarian carcinoma: clinical analysis of 13 cases

目的探讨卵巢上皮性癌脑转移的发生率、临床病理特征、治疗方法及预后。方法回顾性分析中山大学肿瘤防治中心1995年1月至2009年12月收治的13例卵巢上皮性癌脑转移患者的临床资料。结果13例患者占同期收治的卵巢上皮性癌患者的0．7％（13／1851），诊断脑转移时中位年龄48岁。从确诊为卵巢上皮性癌至发生脑转移的中位间隔时间为16个月。初诊时76．9％（10／13）的患者为晚期，病理类型多为浆液性腺癌（10例），病理分级低分化12例、中分化1例。脑转移最常见的首发症状为头痛，颅内病变主要累及双大脑各叶，其次为小脑，累及脑膜者少见。8例患者同时合并颅外脏器转移。发生脑转移后的总体生存时间为O．5—172个月，中位生存时间7个月，大部分患者（10／13）在诊断脑转移后1年内死亡。结论卵巢上皮性癌脑转移发病率低，以低分化浆液性腺癌多见，预后差。个体化综合治疗可改善症状，延长生存期。

Objective To evaluate the incidence, clinicalpathological characteristics, treatment and prognosis of patients with brain metastases from epithelial ovarian carcinoma. Methods The medical records of 13 cases with brain metasta-ses from epithelial ovarian carcinoma treated in Sun Yat-sen University Cancer Center between January 1995 and Decem-ber 2009 were analyzed retrospectively. Results Thirteen patients accounted for 0. 7% of the 1851 women with epitheli- al ovarian carcinoma in the period. The median age at diagnosis of brain metastases was 48 years. The median interval between primary diagnosis and brain metastases was 16 months （range, 1 - 38 months）. 76.9% （10/13） of the cases had advanced stages at primary diagnosis. Serous adenocarcinoma was the prevalent cell type （10/13）. Twelve patients had poorly differentiated tumors, and one had moderately differentiated tumor. The most common symptom of brain metas-tasis was headache. Intracranial metastatic lesions generally involved cerebrum, followed by cerebellum, while leptomen-inges was an uncommon site involved. Eight patients also had extracranial metastases. The median survival from the diag-nosis of brain metastases was 7 months （range, 0. 5 - 172 months）. Most patients （10/13） died within one year. Con-clusions Brain metastases from epithelial ovarian carcinoma present an uncommon event and suggest a poor prognosis. It usually occurred in poorly differentiated serous adenocarcinoma patients. Individual comprehensive treatments can allevi-ate the neurologic symptoms and prolong survival time.