早期卵巢透明细胞癌再分期手术的意义

The Significance of Restaging Surgery for Early Stage Ovarian Clear Cell Carcinoma

目的:探讨卵巢透明细胞癌(OCCC)再分期手术的意义及价值。方法:回顾性分析2015年2月至2019年12月北京协和医院收治的施行再分期手术的OCCC患者40例,记录患者年龄、手术方式、术中情况、再次分期手术方式、国际妇产科联盟(FIGO)分期、病理结果及随诊信息。计算并比较患者生存期及无进展生存期,预后分析采用Cox风险回归模型。结果:(1)患者初次治疗时术中情况:患者中位年龄43.5岁(22~62岁),肿瘤平均大小9.6±3.8 cm。初次手术行冰冻病理检查者18例(45.0%),其中良性病变5例,恶性病变6例,不除外恶性病变7例。初次手术行囊肿剔除术10例,附件切除术23例。术中留取腹腔冲洗液19例(47.5%),腹水瘤细胞阳性5例。(2)再分期手术及FIGO分期:初次手术与再分期手术中位间隔时间为1.35(0.5~4.1)个月,再分期术前行化疗10例(25.0%)。FIGO分期提高为Ⅱ期者1例(2.5%),提高为Ⅲ期4例(10.0%),淋巴结转移率7.5%。(3)患者随诊、预后及影响因素分析:中位随诊时间为48.6个月(5.8~87.1个月),随诊期间复发4例,复发率10.0%。FIGOⅠ期复发3例,复发率8.6%,死亡2例,死亡率5.7%,FIGO分期Ⅱ~Ⅲ期复发1例,复发率20.0%,死亡1例,死亡率20.0%。FIGOⅠ~Ⅱ期与Ⅲ期3年无进展生存率分别为94.3%,66.7%。单因素COX回归分析结果显示合并子宫内膜异位症、术中肿瘤破裂、合并粘连、两次手术间隔并未影响患者预后。结论:OCCC病变局限于卵巢者,再分期手术时分期提高及淋巴结转移率均较低,初次手术并未增加播散转移风险,且诊断与再分期手术间的延迟时间并未影响患者预后。但应提高初次手术对可疑早期OCCC的诊断率,降低再次分期手术给患者带来的创伤。

Objective:To explore the significance and value of restaging surgery for ovarian clear cell carcinoma(OCCC).Methods:A retrospective analysis was performed on 40 patients with OCCC who underwent restaging surgery in Peking Union Medical College Hospital from February 2015 to December 2019.The age,surgical procedure,intraoperative conditions,restaging surgery mode,FIGO stage,pathological results and follow-up information were recorded in detail.Calculate and compare patient survival and progression free survival period.COX risk regression model was used for prognostic analysis.Results:①Intraoperative condition of the patient during the initial treatment:the median age of patients was 43.5 years old(22-62 years old),and the mean tumor size was 9.6±3.8 cm.Among the 18 patients(45.0%)who underwent frozen pathological analysis at the initial operation,the results indicated 5 cases of benign lesions,6 cases of malignant lesions,and 7 cases which cannot exclude malignant lesions of malignant lesions.In the initial operation,10 cases underwent cyst excision,23 cases underwent adnexectomy.During the operation,19 cases(47.5%)of peritoneal fluid was retained,and 5 cases were positive for ascites tumor cells.②Restaging operation and FIGO staging:the median interval between the initial operation and restaging surgery was 1.35(0.5-4.1)months,and 10 cases(25.0%)received chemotherapy before restaging surgery.FIGO staging was increased to stageⅡin 1 case(2.5%)and to stageⅢin 4 cases(10%),and lymph node metastasis rate was 7.5%.③Follow-up,prognosis,and influencing factor analysis:the median follow-up time was 48.6 months(5.8-87.1 months),and 4 cases relapsed during the follow-up period with a recurrence rate of 10.0%.There were 3 cases of recurrence at FIGO stage I,with a recurrence rate of 8.6%,2 cases deaths,and a mortality rate of 5.7%.There was 1 case of recurrence at FIGO stageⅡ/Ⅲ,with a recurrence rate of 20.0%,1 death,and a mortality rate of 20.0%.The 3-year progression-free survival rates of FIGOⅠ/ⅡandⅢwere 94.3%and 66.7%.Single factor COX regression analysis showed that the combination of endometriosis,intraoperative tumor rupture,adhesion and the interval between two operations did not affect the prognosis.Conclusions:In patients with OCCC lesions limited to the ovaries,the rate of upstaging and lymph node metastasis was low.The initial surgery did not increase the risk of spread and metastasis,and the delay between diagnosis and restaging surgery did not affect the prognosis of patients.However,it is necessary to improve the diagnosis rate of suspected early OCCC during initial surgery and reduce the trauma caused by the restaging surgery.