136例原发性卵巢透明细胞癌临床病理特征及预后分析

目的：探讨卵巢透明细胞癌（ovarian clear cell adenocarcinoma，OCCA）的临床病理特征和预后，以提高对该病的诊断、治疗与预后。方法收集136例OCCA患者的临床资料，分析患者的临床病理特征与预后的关系。采用Cox比例风险回归模型分析影响患者预后的因素。结果136例OCCA患者的总体5年生存率为40.8%，其中Ⅰ、Ⅱ、Ⅲ、Ⅳ期分别为70.7%、66.4%、15.9%、0。国际妇产科联合会（International Federation of Gynecology and Obstetrics，FIGO）术后病理分期为Ⅰ、Ⅱ、Ⅲ、Ⅳ期者分别为47.1%（64/136）、11.8%（16/136）、33.8%（46/136）、7.4%（10/136）。并发子宫内膜异位症38例（38/136，27.9%）。复发率41.9%（40/136）。单因素分析结果显示FIGO分期、是否并发子宫内膜异位症、淋巴结转移、残存肿瘤大小、足够的化疗疗程、无进展生存时间（progression free survival，PFS）是影响患者预后的因素（P＜0.05），而患者的发病年龄、腹腔积液/腹腔冲洗液细胞学结果、盆腔肿物大小和不同的化疗方案与预后无关（P＞0.05）。多因素分析结果显示PFS是OCCA患者预后的独立影响因素（P＜0.05）。结论满意的肿瘤细胞减灭术加上术后规范的辅助化疗可能改善OCCA患者的预后。

Clinicopathological features and prognostic factors of 136 cases of primary ovarian clear cell adenocarcinoma

Objective To investigate the clinicopathological features and prognosis of ovarian clear cell adenocar-cinoma (OCCA) and to improve the diagnosis, treatment and prognosis of this disease. Method The clinicopatholog-ical data of 136 patients with OCCA were analyzed retrospectively. Cox proportional hazards regression model were used to analyze those factors affecting prognosis. Result The overall 5-year survival rate was 40.8%, and for all pa-tients, the 5-year survival was 70.7% for those in stage I, 66.4% for stage II, 15.9% for stage III, and 0 for stage IV, respectively. As for FIGO staging, 47.1% (64/136) patients were in stage I, 11.8% (16/136) in stage II, 3.8% (46/136) stage III, and 7.4% (10/136) in stage IV. There were 38 (38/136, 27.9%) patients who had concurrent endometriosis. The recurrence rate was 41.9% (40/136). Univariate analysis showed that the FIGO staging, concurrent endometriosis, lymphatic metastasis, residual tumor diameter, sufficient chemotherapeutic cycles and progression free survival (PFS) (all P<0.05) were prognostic factors, while age of patients at diagnosis, peritoneal cytological status, tumor diameter and different chemotherapy regimes (all P>0.05) were not. Cox multivariate analysis showed that PFS was an inde-pendent prognostic factor for OCCA (P<0.05). Conclusion Our results suggest that optimal cytoreductive surgery and sufficient postoperative chemotherapy can improve the prognosis of patients with OCCA.