年轻妇女卵巢上皮癌的临床特点及预后分析

背景与目的:卵巢上皮癌多发生于老年妇女,年轻妇女较少见.有关35岁以下妇女卵巢上皮癌的临床特点、预后因素分析报道较少.本研究旨在探讨年轻妇女卵巢上皮癌的临床特点、治疗、生存率及预后因素分析.方法:回顾性分析1980年1月至2003年12月我院收治的71例≤35岁的卵巢上皮癌患者的临床资料.生存率用寿命表法计算.利用Cox模型分析比较影响预后的因素.结果:71例确诊为卵巢上皮癌患者中位年龄28岁.临床表现为自扪及腹部包块或体检发现腹部包块18例,腹痛、腹胀各11例.肿物最大径平均为13.7 cm,肿瘤位于单侧52例(73.2%),68例(95.7%)行满意细胞减灭术,手术病理分期I期44例(62.O%)、Ⅱ期5例、Ⅲ期18例、Ⅳ期4例.病理类型以浆液性囊腺癌(40例,56.3%)和粘液性囊腺癌(22例,30.9%)为最多.病理分级为高分化42例(59.2%)、中分化18例(25.4%)、低分化11例(15.5%).68例术前或术后进行了以铂类和紫杉醇类为基础的化疗.15例保守手术中(均为I a、G1期患者),12例无瘤生存(80.0%).按寿命表法计算的2年生存率为86.0%.5年生存率为82.0%.Cox模型多因素分析显示病理分级、残留病灶大小是影响年轻妇女卵巢上皮癌预后的因素(P<0.05).结论:35岁以下妇女卵巢上皮癌患者,以单侧多见,以浆液性囊腺癌多见,预后好.部分I a、G1期患者可保留生育功能.病理分级、残留病灶大小是影响35岁以下妇女卵巢上皮癌预后的因素.

Clinical characteristics and prognosis of epithelial ovarian cancer in young women

BACKGROUND & OBJECTIVE: Epithelial ovarian cancer mostly appears in aged women, but rarely in young women. Little is known about the clinical characteristics and prognosis of epithelial ovarian cancer in women aged below 35 years. This study was to evaluate the clinical characteristics, treatment, survival and prognosis of young patients with epithelial ovarian cancer. METHODS: A total of 71 patients with confirmed epithelial ovarian cancer under the age of 35 years between Jun.1980 and Dec. 2003 were retrospectively analyzed. The survival rate was calculated using the life table method. Cox model was used to determine prognostic factors. RESULTS: The medium age of the 71 patients was 28 years. The common symptoms included self-detected pelvic masses or pelvic masses found at the check-up (18 cases), abdominal pain and abdomen distension (11 cases). The average maximum diameter of the tumor was 13.7 cm. The tumor was located at one side of the ovary in 52 cases (73.2%). Sixty-eight cases underwent optimal cytoreduction. Forty-four patients were classified as stage I (62.0%), five patients were stage II, 18 patients were stage III, and four patients were stage IV. Serous adenocarcinoma (40 cases, 56.3%) and mucinous adenocarcinoma (22 cases, 30.9%) were the most common pathologic types. There were 42 cases (59.2%) of well-differentiated tumor, 18 cases (25.4%) of moderately-differentiated tumor and 11 cases (15.5%) of poorly differentiated tumor. Sixty-eight patients received platinum and paclitaxel-based chemotherapy before or after operation. Twelve patients achieved tumor free survival (80.0%) out of 15 patients (Ia, G1) underwent conservative surgery. The 2- and 5-year survival rates were 86.0% and 82.0%, respectively. Pathological grade and residual tumor size were independent prognostic factors affecting ovarian cancer. CONCLUSIONS: Young women with epithelial ovarian cancer under the age of 35 years mostly have serous adenocarinoma; tumors are normally unilateral; and the prognosis is good. The ovarian function can be preserved in part of stage Ia and Grade I patients. Pathological grade and residual tumor size are independent prognostic factors of epithelial ovarian cancer.