结直肠癌卵巢转移的检测及外科干预分析

Detection of ovarian metastasis of colorectal cancer and analysis of surgical intervention

目的本研究旨在通过回顾性分析患者临床病理资料,对结直肠癌卵巢转移的血清学检测指标和不同手术方式(单侧/对侧切除)的进行分析及探讨。方法回顾性分析2006年1月至2022年11月北京大学肿瘤医院收治的92例结直肠癌卵巢转移患者的临床病例资料。比较分析所有患者术前癌胚抗原(CEA)、CA19-9、CA125及CA125/CEA。对76例行双侧卵巢切除术的患者和16例行双侧卵巢切除术的患者进行了配对研究,以比较手术结果,组间比较采用单因素方差分析。结果本研究共纳入92例患者作为研究对象,平均年龄51.0(19.0~79.0)岁,其中同步转移33(35.9%)例,异时转移59(64.1%)例,异时转移时间11.0(0.5~81.0)个月,76(82.6%)例行双侧卵巢切除,术后病理提示:双侧转移患者48(63.2%)例,只有一侧转移共28例(36.6%),16例(17.4%)行单侧卵巢切除,9例(56.2%)发生术后对侧卵巢转移。71例(77.2%)患者术前血清CEA值异常,80例(87.0%)患者术前CA125和CEA的比值<25,CEA与CA125和CEA的比值比较,差异无统计学意义(χ^(2)=2.991,P>0.05)。结论使用CEA或CA125/CEA<25的指标可作为结直肠癌卵巢转移的辅助诊断工具。结直肠癌卵巢单侧转移,在条件允许的情况下建议同时行双侧卵巢切除,以去除对侧隐匿性异时转移。

Objective To retrospectively analyze the clinicopathological data of patients with ovarian metastasis of colorectal cancer,and to analyze and discuss the serological indicators and different surgical methods(unilateral/contralateral resection).Methods The clinical data of 92 patients with ovarian metastasis of colorectal cancer admitted to Peking University Cancer Hospital from January 2006 to November 2022 were retrospectively analyzed.Preoperative serum level of carcinoembryonic antigen(CEA),CA19-9,CA125 and CA125/CEA were compared in all patients.A paired study of 76 patients who underwent bilateral oophorectomy and 16 patients who underwent bilateral oophorectomy was conducted to compare surgical outcomes.One way ANOVA was used for comparison between groups.Results A total of 92 patients with an average age of 51.0(19.0-79.0)years were included in this study,including 33(35.9%)patients with synchronous metastasis,59(64.1%)patients with heterogeneous metastasis,11.0(0.5-81.0)months with heterogeneous metastasis,and 76(82.6%)patients who underwent bilateral ovariectomy.Postoperative pathology suggested:There were 48 cases(63.2%)with bilateral metastasis,28 cases(36.6%)with unilateral metastasis,16 cases(17.4%)with unilateral ovariectomy,and 9 cases(56.2%)with contralateral ovarian metastasis.71 cases(77.2%)of the patients had abnormal serum CEA values before surgery,80 cases(87.0%)of the patients had CA125/CEA<25,CEA vs.CA125/CEA:χ^(2)=2.991,P>0.05.Conclusion CEA or CA125/CEA<25 can be used as an auxiliary diagnostic tool for ovarian metastasis of colorectal cancer.Unilateral ovarian metastases in colorectal cancer.Simultaneous bilateral ovariectomy is recommended to remove the contralateral latent heterochronous metastases once the conditions are permit.