胃、结直肠癌卵巢转移的预后影响因素分析

Prognostic factors of metastatic ovarian tumors of gastric and colorectal cancer

目的探讨胃、结直肠癌卵巢转移患者的临床特点及其预后影响因素。方法采用回顾性分析方法,收集海军军医大学第一附属医院2010年1月至2020年8月住院部诊治的92例胃、结直肠癌来源的卵巢转移性肿瘤患者的临床资料,对其临床特征及实验室指标进行分析,进而分析影响其生存和预后的因素。结果92例患者中癌胚抗原(carcinoembryonic antigen,CEA)阳性者、糖类抗原125(carbolydrate antigen 125,CA125)阳性者数量均不足一半,影像学上以5~10 cm的实性或囊实性包块为主。患者中位生存时间为16个月,总体1年、2年、3年生存率分别为55.9%、36.8%、17.6%。单因素分析显示,CA125阴性、CA125/CEA<5、原发性肿瘤来源为结直肠癌、原发性肿瘤病理类型为腺癌、原发性肿瘤手术、无卵巢外转移、卵巢转移灶术后无残留灶、卵巢转移灶无脉管侵犯、单侧卵巢转移、卵巢转移灶<5 cm、卵巢转移灶影像学特征含囊性成分、卵巢转移灶病理类型为单纯腺癌的患者预后较好。另外,免疫组化标志物尾型同源框转录因子2(caudal type homeobox 2,CDX2)表达影响预后生存时间(P=0.001)。多因素COX回归分析显示,原发性肿瘤部位(P=0.023)、卵巢转移灶<5 cm(P=0.031)、卵巢转移灶P53表达(P=0.007)是胃、结直肠癌卵巢转移性肿瘤的独立预后因素。结论胃、结直肠癌卵巢转移性肿瘤患者发病年龄范围大,临床表现无明显特异性,影像学上以含实性或囊实性成分的包块为主,患者预后差,但结直肠癌来源者预后好于胃癌来源者,卵巢转移灶<5 cm者较5~10 cm者预后更好,免疫组化标志物P53表达可能是胃、结直肠癌卵巢转移性肿瘤患者的保护因素。

Objective To explore the clinical characteristics and factors affecting the prognosis of metastatic ovarian tumors of gastric and colorectal cancer.Methods Clinical data of 92 hospitalized patients with metastatic ovarian tumors of gastric and colorectal cancer in The First Affiliated Hospital of Naval Medical University from January 2010 to August 2020 were selected and analyzed retrospectively.The clinical characteristics,related laboratory data,survival and prognostic factors were statistically analyzed.Results There were less than half of carcinoembryonic antigen(CEA)-positive cases and less than half of carbolydrate antigen 125(CA125)-positive cases in the 92 cases.Medium-sized solid or cystic solid masses(5-10 cm)mainly presented on imaging.The median survival time of the patients was 16 months,and 1-,2-and 3-year overall survivals were 55.9%,36.8%and 17.6%,respectively.Univariate analysis showed that negative CA125,CA125/CEA<5,colorectal origin,adenocarcinoma of primary tumor,the resection of primary tumor,no external ovarian metastases,no residual of metastatic lesions after surgery,no vascular invasion of ovarian metastases,unilateral ovarian mass,ovarian mass less than 5 cm,ovarian metastases containing cystic components,and adenocarcinoma of ovarian metastases were related to a good prognosis.The expression of caudal type homeobox 2(CDX2)affected the survival time(P=0.001).COX regression multivariate analysis identified that the primary tumor site(P=0.023),ovarian mass<5 cm(P=0.031),and the expression of P53 in ovarian metastasis(P=0.007)were independent prognostic factors for metastatic ovarian tumors of gastric and colorectal cancer.Conclusion There is a wide range of onset age of patients with metastatic ovarian tumors of gastric and colorectal cancer.The clinical manifestations were nontypical,and medium-sized masses containing solid components mainly present on imaging.The prognosis is poor,but the patients with colorectal origin have better prognosis than patients with gastric origin.The prognosis of patients with ovarian mass<5 cm is good.The expression of P53 may be a protective factor for those patients.