卵巢癌肺转移患者的临床特征、治疗及预后

Clinicopathological Features,Management and Prognosis of Ovarian Cancer Patients with Lung Metastasis

目的:探讨卵巢癌肺转移患者的临床特征、治疗及预后,为卵巢癌肺转移患者诊疗提供循证证据。方法:回顾性分析2010年1月至2022年1月北京大学人民医院收治的卵巢癌肺转移患者的临床资料,包括临床病理特征、治疗及随访相关数据。按治疗方法分为非手术组和胸部手术组,其中后者按手术途径分为经典开胸手术组和电视辅助胸腔镜手术(video-assisted thoracic surgery,VATS)组。结果:共纳入42例卵巢癌肺转移患者,平均年龄(52.1±13.2)岁,病理类型以高级别浆液性癌为主。非手术组32例,胸部手术组10例,其中手术组开胸1例,VATS 9例;手术方式包括肺叶楔形切除术、肺叶切除和肺段切除术等。术后病理:10例均为卵巢癌肺转移。Cox单因素分析结果显示:是否肺部手术(HR=0.213,95%CI:0.061~0.742,P=0.015)、是否合并肺外转移(HR=0.208,95%CI:0.048~0.896,P=0.035)、肺转移数目(HR=0.123,95%CI:0.016~0.923,P=0.042)是卵巢癌肺转移患者肺转移后总生存时间(post-lung metastases overall survival,PLM-OS)的预后因素;是否肺部手术(HR=0.367,95%CI:0.173~0.982,P=0.046)是卵巢癌肺转移患者肺转移后无进展生存期(post-lung metastases progression-free survival,PLM-PFS)的预后因素。Cox多因素生存分析结果提示是否手术、是否合并肺外转移、肺转移数目对PLMPFS的HR值分别为0.495(95%CI:0.113~2.162)、0.983(95%CI:0.332~2.912)、0.642(95%CI:0.098~4.208);对PLM-OS的HR值分别为0.458(95%CI:0.102~2.053)、0.389(95%CI:0.083~1.824)、0.379(95%CI:0.032~4.529)。结论:严格手术适应证的情况下,卵巢癌肺转移可行手术治疗;肺部手术、是否合并肺外转移及肺转移数目是卵巢癌肺转移患者预后影响因素,今后仍需大样本研究支持。

Objective:To explore the clinical characteristics,treatment and prognostic factors of ovarian cancer patients with lung metastasis,and provide a basis for the diagnosis and treatment of patients with lung metastasis.Methods:Clinical data,including clinicopathological features,treatments and follow-ups,of ovarian cancer patients with lung metastasis admitted to Peking University People’s Hospital from January 2010 to January 2022 were retrospectively analyzed.The patients were assigned to the non-surgical group and the thoracic surgery group[including classical open thoracic surgery and video-assisted thoracic surgery(VATS)].Results:A total of 42 ovarian cancer patients with lung metastasis were collected,with including 32 cases in the non-surgical group and 10 cases in the thoracic surgery group[including open thoracic surgery(n=1)and VATS(n=9)].The average age was(52.1±13.2)years old.The pathological type was mainly high-grade serous carcinoma.The surgical modalities included wedge resection of the lung lobes,lobectomy and segmentectomy.All 10 surgery cases were proved to be lung metastasis by postoperative pathology.Cox univariate analysis showed that the presence of thoracic surgery(HR=0.213,95%CI:0.061~0.742,P=0.015),the presence of extrapulmonary metastasis(HR=0.208,95%CI:0.048~0.896,P=0.035),and number of pulmonary metastases(HR=0.123,95%CI:0.016~0.923,P=0.042)were the prognostic factors of post-lung metastases overall survival(PLM-OS)in ovarian cancer patients with lung metastasis;the presence of thoracic surgery(HR=0.367,95%CI:0.173~0.982,P=0.046)was a prognostic factor for post-lung metastases progression-free survival(PLM-PFS)in ovarian cancer patients with lung metastasis.The Cox multivariate survival analysis suggested that HR values of the presence of surgery,the presence of extrapulmonary metastasis,and the number of lung metastasis for PLM-PFS were 0.495(95%CI:0.113~2.162),0.983(95%CI:0.332~2.9912)and 0.642(95%CI:0.098~4.208);and that the HR values of those factors for PLM-OS were 0.458(95%CI:0.102~2.053),0.389(95%CI:0.083~1.824)and 0.379(95%CI:0.032~4.529).Conclusion:With strict surgical indications,surgical treatment is feasible for lung metastasis of ovarian cancer.Pulmonary surgery,the presence of extrapulmonary metastasis and the number of pulmonary metastases are the prognosis factors of ovarian cancer with lung metastasis,which need to be supported by larger sample studies.