卵巢上皮性癌脐转移临床特征分析

Umbilicus metastasis in patients with epithelial ovarian cancer： clinical features of 21 patients

目的 分析卵巢上皮性癌（EOC）脐转移的临床特点,探讨其发生率、诊断、治疗及预后相关因素.方法 回顾性分析1991年1月至2011年1月中山大学肿瘤防治中心收治的EOC患者2642例中经不同取材病理组织学确诊发生脐转移的21例患者的临床病理资料,21例年龄40～66岁.结果 EOC脐转移的发生率为0.79％.未控或复发转移至脐者较初始治疗时已有脐转移者预后差（22比6个月,P＜0.01）,行姑息或不规则治疗者较采取积极规范手术联合规则化疗者的预后差（21比4个月,P＜0.01）.脐转移的确诊时间及确诊后的治疗措施是影响预后的独立危险因素.结论 提高对EOC患者发生脐转移诊断的警惕性,综合评估病情及治疗耐受,采取积极的肿瘤细胞减灭术配合规则化疗为主的综合治疗有助于此类患者病情的控制并延长其生存时间.

Objective To analyze the clinical features,treatments and prognosis of patients with Sister Mary Joseph＇s nodule of umbilicus （SMJN） from epithelial ovarian cancer （EOC） patients.Methods Among a total of 2642 pathologically diagnosed EOC cases,21 cases with SMJN were histopathologically diagnosed and had an age range of 40-66 years at Sun Yat-sen University Cancer Center between January 1991 and January 2011.Their clinical data were retrospectively analyzed.Results The incidence of SMJN in EOC was 0.79%.The 1,2 and 5-year survival rates were 61.8%,26.8% and 9.5% respectively.The diagnosis was confirmed via local excision biopsy,fine-needle aspiration biopsy or gross pathological diagnosis.Univariate analysis showed that patients with progressive disease or relapsing with umbilical metastasis after treatment had worse prognosis than those diagnosed at pre-treatment （22 vs 6 months,P 〈 0.01）.Patients with suboptional cytoreductive surgery and/or less than 6 circles of chemotherapy or palliative treatment had worse prognosis than those with optional cytoreductive surgery during 6-8 circles of chemotherapy （21 vs 4 months）.Multivarivate analysis showed that the time to diagnose and treatment regimen were independent predictors of survival （relative risk =41.28,P 〈 0.01）.Conclusion SMJN is a rare manifestation of EOC.Improving the diagnostic vigilance,optimal debulking surgery plus regular chemotherapy and other new individualized postoperative treatments may arrest the progression of EOC and prolong patient survival.