83例胃癌卵巢转移临床病理特征及预后分析

Clinicopathological characteristics and prognostic factors of 83 patients with ovarian metastasis from gastric cancer

目的:探讨胃癌卵巢转移患者临床病理特征及影响预后的因素.方法:回顾性分析2006年1月至2017年12月83例于解放军总医院诊治胃癌卵巢转移患者的临床资料及治疗方法,对可能影响预后的因素行单因素或多因素分析.结果:83例患者中卵巢转移的中位直径为7.1(1.0~24.0)cm,转移病灶位于单侧36例(43.4%),位于双侧47例(56.6%),同时伴有腹膜转移35例(42.2%).全组患者均行化疗,联合转移病灶切除57例(68.7%),腹腔热灌注化疗22例(26.5%).74例(89.1%)完成随访,中位生存期15(12.5~17.5)个月,1、3、5年生存率分别为71.1%、6.5%、0.单因素分析显示原发病灶淋巴结转移大于6个、转移病灶切除、同时性胃癌卵巢转移、合并腹膜转移、免疫组织化学法检测ER阳性、血清CEA及CA125升高是影响预后的因素(均P<0.05),多因素分析显示转移病灶切除、同时性胃癌卵巢转移、合并腹膜转移、免疫组织化学法检测ER阳性是影响预后的独立因素(均P<0.05).结论:同时性胃癌卵巢转移、合并腹膜转移患者预后较差,免疫组织化学法检测ER阳性患者预后好于阴性患者,转移病灶切除可延长患者的生存时间.

Objective:To explore the clinicopathological characteristics and prognostic factors of patients with ovarian metastasis from gastric cancer.Methods:We retrospectively analyzed the clinical data and treatment strategies of 83 patients with metastatic ovarian tumors treated at PLA General Hospital between January 2006 and December 2017.Univariate analysis using the Log-rank test and multivariate analysis using the Cox proportional-hazards model were used to identify the prognostic factors.Results:The median diam-eter of the metastatic ovarian tumors was 7.1(1.0-24.0)cm.Of these patients,36(43.4%)had unilateral metastasis and 47(56.6%)had bilateral metastasis;35(42.2%)patients had peritoneal metastasis.All patients received chemotherapy,including 57(68.7%)pa-tients who underwent combined-modality resection of the metastatic tumors and 22 patients(26.5%)who received hyperthermic in-traperitoneal chemotherapy.Of these patients,74(89.1%)were followed up,with a median survival time of 15[95%confidence inter-val(CI):12.5-17.5]months.The 1-year,3-year,and 5-year overall survival rates were 71.1%,6.5%,and 0,respectively.Univariate analy-sis showed that risk factors including≥6 metastatic lymph nodes,metastasectomy,synchronous ovarian metastasis,peritoneal carcino-matosis,estrogen receptor(ER)positivity,and high levels of serum carcinoembryonic antigen and cancer antigen-125(CA125)might affect the prognosis(P<0.05).Multivariate analysis showed that metastasectomy,synchronous ovarian metastasis,combined peritoneal carcinomatosis,and ER positivity were independent factors affecting prognosis(P<0.05).Conclusions:We found that the presence of synchronous ovarian metastasis or combined peritoneal carcinomatosis indicated a poor prognosis;in contrast,ER-positivity predicted a better prognosis than ER-negativity.Metastasectomy may prolong the survival of patients.