63例胃癌异时性卵巢转移临床病理特征及预后分析

Clinicopathologic characteristics and prognostic factors of 63 gastric cancer patients with metachronous ovarian metastasis

目的:探讨胃癌异时性卵巢转移患者的临床病理特征及影响预后的因素。方法:收集1999年1月至2011年12月中国医学科学院肿瘤医院收治的63例胃癌术后异时性卵巢转移患者的临床病理资料,采用Log rank检验分析生存情况,单因素分析可能影响预后的因素,多因素分析采用Cox回归模型。结果:本组胃癌术后卵巢转移发生率为3.4%(63/1 856),平均年龄45岁,65.1%(41/63)为绝经前患者,卵巢转移与原发癌间隔时间平均为16个月;原发胃癌以低分化癌为主,87.3%(55/63)侵犯浆膜,N2～3淋巴结转移者占68.3%(43/63);85.7%(54/63)为双侧卵巢转移,73.0%(46/63)同时合并腹膜转移,31.7%(20/63)行转移病灶完全切除。全组中位生存期13.6个月,1、2、3年生存率分别为52.5%、22.0%和9.8%,5年生存率为0。单因素分析结果显示,腹膜种植转移、脉管瘤栓、病灶切除范围以及辅以化疗的综合治疗模式为影响患者预后的相关因素(均P<0.05)。多因素分析结果显示,腹膜种植转移是影响胃癌卵巢转移患者预后的独立危险因素(P<0.01)。结论:有效防治腹膜种植转移是改善胃癌卵巢转移患者预后的关键。

Objective： This work aimed to explore the clinicopathologic characteristics and prognostic factors of gastric cancer patients with metachronous ovarian metastasis. Methods：The clinicopathologic data of 63 post-operative gastric cancer patients with the complication of metachronous ovarian metastasis were collected. The patients were admitted to the Cancer Institute and Hospital, Chinese Academy of Medical Science and Peking Union Medical College, Beijing from January 1999 to December 2011. Log-rank test was conducted for survival analyses. Univariate analysis was used for possible prognostic factors affecting the survivals. Cox regression model was used for multivariate analysis. Results：The incidence of ovarian metastasis was 3.4%with a mean age of 45 years. Among all patients, 65.1% were pre-menopausal. The mean time interval between ovarian metastasis and primary cancer was 16 months. Low-differentiated carcinoma ranked first in the primary gastric cancers. The majority of lesions occurred in the serous membrane （87.3%）. The metastatic sites included N2-3 lymph node （68.3%）, bilateral ovaries （85.7%）, and peritoneal membrane （73%）. Total resection of metastasized sites was performed （31.7%）. The overall median survival was 13.6 months, whereas the overall 1-, 2-, and 3-year survival rates were 52.5%, 22.0%, and 9.8%, respectively. The 5-year survival rate was zero. Univariate analysis showed that the patient＇s prognosis was correlated with peritoneal seeding metastasis, vascular tumor embolus, range of lesion excision, and mode of comprehensive treatment with adjuvant chemotherapy （P〈0.05）. Multivariate analysis indicated that peritoneal seeding metastasis was an independent prognostic factor for gastric cancer patients with ovarian metastasis （P〈0.01）. Conclusion： Effective control of peritoneal seeding-induced metastasis is important in improving the prognosis of the gastric cancer patients with ovarian metastasis.