卵巢低级别浆液性癌患者的临床特点分析

Clinical features of low-grade serous ovarian cancer

目的:探讨卵巢低级别浆液性癌患者的临床和治疗特点。方法:回顾分析2010年1月至2020年6月在北京大学人民医院妇科接受治疗的44例卵巢低级别浆液性癌患者的病历资料,包括发病年龄、肿瘤分期、初始手术、一线化疗、新辅助化疗、内分泌治疗、复发治疗等数据。使用Kaplan-Meier生存曲线分析患者的无进展生存时间和总生存时间。结果:患者中位诊断年龄38岁,初诊时Ⅲ期最常见(52.3%)。初始治疗以手术联合含铂辅助化疗为主,晚期患者初次肿瘤细胞减灭术的无肉眼残留率为63.2%,79.0%达到满意减瘤术;6例行新辅助化疗,客观缓解率为83.3%(5/6),5例行间歇性肿瘤细胞减灭术,均无残留病灶。初始治疗后42例病情完全或部分缓解。14例(33.3%)出现至少1次复发,第1次复发以手术为主,辅以铂类化疗和内分泌治疗。中位随访时间73.0个月,初治后中位无进展生存时间83.0个月,5年生存率85.2%,中位总生存时间未达到。结论:卵巢低级别浆液性癌多在中青年发病,Ⅲ期最常见。无论初治和复发患者,手术治疗最重要,应以无残留病灶为目标。一线化疗方案仍是铂类为基础的联合方案,尽管化疗相对耐药,晚期患者也可考虑新辅助化疗,内分泌治疗有重要地位,总体预后好于卵巢高级别浆液性癌。

Objective:To explore the clinical features and treatment strategy of patients with low-grade serous ovarian cancer.Methods:Medical records of 44 patients with low-grade serous ovarian cancer who underwent treatment at Peking University People's Hospital from January 2010 to June 2020 were analyzed,including the age at diagnosis,FIGO stage,primary surgery,first-line chemotherapy,endocrine therapy,recurrence treatment and other data.Kaplan-Meier survival curves were used to analyze the progression-free survival and overall survival of the patients.Results:The median age at diagnosis was 38 years old,and FIGOⅢwas the most common at diagnosis(52.3%).The main initial treatment was primary surgery followed by platinum-based adjuvant chemotherapy,and the rate of complete gross resection and optimal cytoreduction at primary cytoreductive surgery were 63.2%and 79.0%respectively.6 patients underwent neoadjuvant chemotherapy,and the objective response rate was 83.3%(5/6).5 patients underwent interval cytoreductive surgery and all of them had no residual tumor.42 patients had complete or partial response after initial treatment.14 patients(33.3%)experienced at least one recurrence.At first recurrence,the main treatment was surgery,at the same time,platinum-based chemotherapy and endocrine therapy were also important.The median follow-up time was 73.0 months.The median progression-free survival after initial treatment was 83.0 months.5-year survival rate was 85.2%,and the median overall survival was not reached.Conclusion:Most patients with low-grade serous ovarian cancer were diagnosed at young age.StageⅢwas the most common disease.Regardless of first diagnosis and recurrence,surgery was the most important treatment,and should be aimed at no residual tumor.The first-line chemotherapy was platinum-based combination regimen.Although low-grade serous ovarian cancer was relatively chemoresistant,patients with advanced disease could also be considered to receive neoadjuvant chemotherapy.Endocrine therapy also played an important role in the treatment of low-grade serous ovarian cancer.The prognosis was better than that of high-grade serous ovarian cancer.