卵巢上皮性癌组织黄体生成激素-绒毛膜促性腺激素受体蛋白的表达

目的：探讨卵巢上皮性癌组织黄体生成激素（ＬＨ）与人绒毛膜促性腺激素（ｈＣＧ）受体（ＬＨ－ＣＧ）表达与临床预后的关系。方法：应用Ｗｅｓｔｅｒｎ免疫印迹方法，对４０例卵巢上皮性癌组织ＬＨ－ＣＧ受体蛋白进行半定量分析；应用免疫组化方法检测受体蛋白表达的部位。结果：４０例中，ＬＨ－ＣＧ受体蛋白阳性表达率为７２．５％（２９／４０），其中Ⅰ、Ⅱ期患者高于Ⅲ、Ⅳ期患者，但差异无显著性（Ｐ＞０．０５）。高分化癌的受体含量约为低分化癌的２倍，两组比较，差异有显著性（Ｐ＜０．０５）。ＬＨ－ＣＧ受体蛋白高表达患者的１年和３年生存率分别为８３．９４％和６７．１５％，低表达患者１年和３年生存率均为３３．４３％，两者比较，差异有显著性（Ｐ＜０．０５）。结论：卵巢上皮性癌ＬＨ受体高表达者，预后较低表达者好。     

I期卵巢上皮性癌的预后因素

对我院１９６２年至１９８９年收治的６７例Ｉ期卵巢上皮性癌患者进行回顾性分析。按收治年代将其分为三组。结果：三组除采用的化学疗法（化疗）的方法不同外，其它治疗及患者的临床病理特点比较，差异无显著意义。６０年代（第一组）、７０年代（第二组）、８０年代（第三组）治疗的愚者预后随时间逐步改善，其５年生存率分别为４６％、８２％和９７％。第一组与第二组５年生存率比较，差异有非常显著意义（Ｐ＜０．００１）；第二组与第三组比较，差异有显著意义（Ｐ＜０．０５）。多因素分析显示，化疗及临床分期是影响预后的重要因素（Ｐ均＜０．０１），其次是病理分级（Ｐ＜０．０５）。多疗程联合化疗、Ｉａ期患者及肿瘤分化Ｉ、ＩＩ级患者预后好。本研究还就Ｉ期卵巢上皮性癌的化疗、手术准确分期及保留生育功能进行了讨论。     

卵巢上皮性癌155例的治疗与预后

目的：探讨卵巢上皮性癌的治疗与影响预后的因素。方法：对１９７０年１月至１９９２年１２月在我院治疗的１５５例卵巢上皮性癌进行回顾性分析。全部手术切除标本经病理检查诊断并按ＦＩＧＯ分期标准进行分期，４２例行２次手术，４例行３次手术。除６例外，余１４９例均于手术后行化疗，３２例于第２次术后再次行化疗，９例因复发再次化疗。结果：２年、５年、１０年的生存率分别为Ⅰ期９２．４％、８７．０％、７０．６％；Ⅱ期９１．９％、６３．６％、４７．８％；Ⅲ期５９．９％、３８．２％、１９．２％；Ⅳ期２５．０％、２５．０％、０．０％（Ｐ＜０．００１）。６例未化疗者均在术后２年内死亡。结果表明，预后与临床分期、细胞分化、残留癌灶大小有关。５年生存率中，Ⅰ期为８７．０％和Ⅲ期为３８．２％（Ｐ＜０．００１）；Ｇ１的５年生存率为９５．９％，Ｇ３为１１．８％（Ｐ＜０．００１）；无残留癌灶者为９７．６％，残留癌灶＞２ｃｍ者为２１．２％（Ｐ＜０．００１）。结论：在卵巢上皮性癌初次手术时残留癌灶＜２ｃｍ，并于术后尽早开始化疗，可提高生存率。     

子宫颈癌卵巢转移17例分析

目的：分析宫颈癌特别是早期宫颈癌卵巢转移的危险性。方法：回顾性分析１９５８年至１９９４年我院收治的１７例宫颈癌卵巢转移的情况。结果：１７例患者中，１０例为肉眼可见转移，７例为病理检查证实。１１例（５８．８％）转移至双侧卵巢，１３例同时累及宫体、盆腔及主动脉旁淋巴结。１７例患者中，１０例为宫颈鳞癌卵巢转移，７例为宫颈腺癌卵巢转移，转移率分别为０．０７％和１．８１％，差异有显著性（Ｐ＜０．０５）。１７例患者中，宫颈癌Ⅰ、Ⅱ期者为８例，宫颈鳞癌无Ⅰ期患者，Ⅱ期卵巢转移率为０．０８％；宫颈腺癌Ⅰ期卵巢转移率为９．５％，Ⅱ期为１．２％。手术治疗的Ⅰ、Ⅱ期患者中，宫颈腺癌的卵巢转移率为７．８％，Ⅱ期宫颈鳞癌患者的卵巢转移率为１．６％。１７例患者的预后差，５年生存率为１７．６％。结论：宫颈腺癌早期有发生卵巢转移的危险性。宫颈癌患者是否保留卵巢的问题，值得进一步探讨。     

卵巢正常大小的原发性卵巢上皮性癌综合的临床特点与预后 …

目的 探讨卵巢正常大小的 性卵巢上皮性癌综合征的临床特点及预后因素。方法 对１０例患者的病例资料采用回顾性分析方法。结果 本病多发生于５０岁以上,占８０％;以腹胀、食欲差为首发症状,占９０％;就诊晚,易误诊,误诊率４０％;卵巢均正常大小,盆腹腔有广泛种植,局部聚集成块,占７０％;术后残留灶直径〈２．０ｍｃ患者的生存时间高于术后残留灶直径≥６个者生存时间明显高于疗程数〈６个者（Ｐ〈０．０５）。本组患     

早期成人型卵巢颗粒细胞瘤复发相关因素分析北大核心CSCD

目的探讨国际妇产科联盟(FIGO)(2014版)Ⅰ期成人型卵巢颗粒细胞瘤复发的相关高危因素。方法回顾性分析首都医科大学附属北京朝阳医院及中国医学科学院北京协和医院1995年1月至2010年1月收治的FIGOⅠ期成人型卵巢颗粒细胞瘤。分析患者临床及病理相关因素与肿瘤复发的关系。结果研究共纳入18例FIGOⅠ期成人型卵巢颗粒细胞瘤患者,患者中位年龄为43岁(31~69岁)。初始治疗中7例行单纯肿瘤剥除/单侧附件切除术,8例行子宫双附件切除术,3例行卵巢肿瘤全面分期术。患者术后5年和10年总生存率分别为94.4%和83.3%。共6例患者复发,中位复发时间为76个月。肿瘤直径>10cm、术中瘤体破裂是患者近期复发(<5年)的高危因素。低分化、术中瘤体破裂、高核分裂象(≥4/10HPF)是患者远期复发(≥5年)的高危因素。结论早期成人型卵巢颗粒细胞瘤整体预后好,高核分裂象、术中瘤体破裂可能是早期卵巢颗粒细胞瘤复发的潜在高危因素。     

40岁以下妇女卵巢上皮性癌的临床及病理学特点

目的：了解年龄小于４０岁妇女卵巢上皮性癌在临床及病理学方面的特点。方法：１９７８年１月至１９９２年１２月在我院诊治的年龄小于４０岁卵巢上皮性癌患者共５４例，选择与每一例同期手术、年龄大于４０岁卵巢上皮性癌５４例作为对照组，用ＳＰＳＳ及ＳＵＲＶＡＬ分析软件对两组临床及病理学资料进行对照分析。结果：年龄小于４０岁患者中，因偶然发现盆腹腔包块就诊者（４６．３％）多于对照组（２７．８％），而因出现症状就诊者（５３．７％）少于对照组（７２．２％），其早期诊断率（６１．１％）、肿瘤单侧发生率（６８．５％）、肿瘤最大径线均值（１３．６ｃｍ）、肿瘤分化程度（高分化占５０．０％）以及达到理想肿瘤细胞减灭术者均高于对照组。两组组织学类型及化疗情况相似。单因素分析，年龄小于４０岁患者预后好，其２年及５年生存率分别为６９．８％和５０．２％，８例保留健侧卵巢者均无复发。多因素分析显示年龄对预后无影响。结论：年龄小于４０岁患者的卵巢上皮性癌其分期较早，恶性程度较低，预后较好，部分患者手术时可保留卵巢功能。     

卵巢幼年型颗粒细胞瘤四例临床分析

目的 探讨卵巢幼年型颗粒细胞瘤的诊断,治疗和预后。方法 回顾性分析自1983年至2002年间北京协和医院收治的4例卵巢幼年型颗粒细胞瘤的临床资料。结果 卵巢幼年型颗粒细胞瘤的发生率极低,主要发生在青少年及儿童,临床表现为盆腔实性包块伴胸腹水,4例患者雌二醇水平均在正常范围,手术病理分期为Ⅰ期。确诊主要依据病理检查,所有患者接受手术 化学药物治疗（化疗）。其中,2例呈高核分裂相的患者病情很快恶化,分别于发病后10和14个月死亡;2例低分裂相的患者现无瘤生存分别为32和25个月。结论 卵巢幼年型颗粒细胞瘤的诊断主要依据病理检查,核分裂相高者预后不良,治疗以手术为主,辅以化疗可能改善预后。     

卵巢无性细胞瘤10年生存率随访结果及分析

目的 探讨卵巢无性细胞瘤的治疗与预后。方法 ３４例卵巢无性细胞瘤均采用手术加放疗。结果 ３４例病例中,Ⅰ、Ⅱ期１８例１０年生存率１００％,Ⅲ期１５例１０年生存率为９３．０％,Ⅳ期１例生存１５个月,总生存率为９４．１％,结论 卵巢无性细胞瘤属恶性肿瘤,对放疗及化疗均十分敏感,能获得较佳治疗效果。但应加强随访,随访可采用血乳酸脱氢酶及其同工酶作为判断该肿瘤浸润转移倾向的特异性肿瘤标志物。     

卵巢颗粒细胞瘤的治疗与预后(23例临床分析)

目的 对23例卵巢颗粒细胞瘤的治疗及可能的预后因素进行回顾性分析,探讨手术、化疗、放疗在卵巢颗粒细胞瘤治疗中的意义。方法 研究对象为北京协和医院1980年1月至1999年12月20年间收治的卵巢颗粒细胞瘤患者23例,患者的年龄范围为5～61岁,平均年龄38.4岁。随诊时间为1～14年,随访率为91.4％。统计学分析方法:采用SPSS(version 8.0)进行数据分析,生存率的计算采用Kaplan-Meier法。结果23例卵巢颗粒细胞瘤临床病理分期为Ⅰ期20例,占87.0％,Ⅱ期1例,占4.3％,Ⅲ期2例,占8.7％,临床Ⅰ-Ⅲ期5年生存率在90%以上。病理切片分析,成年型20例,幼年型3例,幼年型患者1年生存率<50%。卵巢颗粒细胞瘤的复发率为34.8％,复发与临床病理分期、手术方式及肿瘤大小有关。结论 卵巢颗粒细胞瘤是一种低度恶性的卵巢肿瘤,生存率高,局部复发,晚期复发。预后相关因素包括临床病理分期、病理类型、肿瘤大小以及初次手术方式。手术治疗仍是卵巢颗粒细胞瘤的主要治疗手段。临床Ⅰc期以上,病理类型不良,肿瘤直径大于l0cm,则最好辅以化疗。放疗主要用于盆腔局部复发、手术难以切除或切净的患者。     

Histopathological prognostic factors of adult granulosa cell tumors of the ovary.

BACKGROUND: The prognostic factors of adult granulosa cell tumor (AGCT) have not been well defined. METHODS: In 27 AGCT patients, we examined clinical stage, microscopic patterns, mitotic index (MI), and lymph-vascular space invasion (LVSI) to determine whether these factors were related to disease-free survival (DFS) of patients with AGCT. We also performed immunohistochemical examination for p53. RESULTS: Seventeen cases represented stage I tumors, four stage II, five stage III, and one stage IV. Patients with stage I disease had more favorable prognosis than those with stage II to IV disease (p=0.034). There was no relation between the microscopic patterns and the DFS. The MI, which was categorized into < or =3/10 high power field (HPF) and > or =4/10 HPF, was significantly related to patients DFS (p<0.0005). The DFS time for patients with moderate or prominent LVSI was significantly shorter than that for patients with no or minimal LVSI (p<0.0001). By multivariate analysis, MI and LVSI were shown to be independent prognostic factors. Five of seven patients with recurrent tumor had extrapelvic spread; two in the abdominal cavity and three in the liver. CONCLUSION: The results of this study suggest that prognosis for patients with AGCT depends on the MI and LVSI. During the follow-up period of patients, they need to be examined for distant metastasis including liver.     

Adult granulosa cell tumor of the ovary: 35 cases in a single Korean Institute

BACKGROUND: Adult granulosa cell tumor of the ovary is an uncommon neoplasm. The overall prognosis is favorable. The prognostic factors that are related to survival have not been well defined and are discussed in the literature amidst controversy. METHODS: Thirty-five patients diagnosed with adult granulosa cell tumor of the ovary were reviewed retrospectively. Demographic data, pathologic findings, treatments, and survival times were reviewed and analyzed for prognostic significance. RESULTS: Of the 35 cases, there were 30 cases representing stage I tumors, one case at stage II, four cases at stage III, and no cases at stage IV. The mean overall survival time of all patients was 140.3 months. The 5- and 10-year survival rates were 92.0% and 85.8% respectively. The FIGO stage was the only independent prognostic factor. CONCLUSIONS: Despite the small number of patients, the study showed that the less advanced stage is the only favorable prognostic factor of significance.     

Leiomyosarcoma of the uterus: clinicopathologic study of 21 cases

A detailed clinicopathologic study of 21 patients with uterine leiomyosarcoma was undertaken. The diagnosis of leiomyosarcoma was made for those uterine smooth muscle tumors showing cellular atypia and 5-9 mitoses per 10 high-powered fields (M/10 HPF) and those with 10 or more M/10 HPF. Using these strict pathologic criteria to define leiomyosarcoma, menopausal status, margin type (pushing vs infiltrating), tumor size, grade, location, and the presence of vascular invasion and/or hemorrhage were not associated with prognosis. The 5-year survival rate was 25%. Survival rates were not improved by the use of adjuvant chemotherapy in those patients rendered free of gross disease by initial surgery.     

Prognostic parameters in endometrial stromal sarcoma: a clinicopathologic study in 31 patients

OBJECTIVE: The aim of this study was to evaluate the behavior of endometrial stromal sarcomas (ESS) in relation to their clinical and pathologic features and to identify possible prognostic factors. METHODS: Thirty-one patients with histologically proven ESS were included in the analysis. Endometrial stromal sarcoma is characterized by proliferations composed of cells with endometrial stromal cell differentiation. A breakpoint of 10 mitoses per 10 high-power fields was used in the statistical analysis to distinguish between low-grade and high-grade endometrial stromal sarcoma and to evaluate the prognostic value of mitotic count in patients with ESS. RESULTS: The median follow-up time was 72 months (range 34-110). The median overall survival of the 31 patients was 127 months, resulting in a 5-year overall survival rate of 62%. Adjuvant therapy was administered to 25 patients; among those, 20 patients received postoperative radiotherapy and 5 patients received chemotherapy. Ten of the irradiated patients and 3 patients undergoing chemotherapy developed disease recurrence. Concerning the response rate to adjuvant chemotherapy, 1 patient showed a complete response, 1 patient a partial response, 1 patient stable disease, and 2 patients progressive disease. Altogether, 14 patients developed recurrent disease with a median disease-free survival of 11 months (range 5-60). Twelve patients died of the disease. A univariate model revealed that early tumor stage (P < 0.0007), low myometrial invasion (P < 0.008), and low mitotic count (P < 0.005) were associated with a lengthened overall survival in patients with endometrial stromal sarcoma. Age and adjuvant therapy did not influence overall survival of patients with ESS. CONCLUSION: Early tumor stage, low myometrial invasion, and low mitotic count are associated with a lengthened overall survival in patients with ESS.     

Long-term follow-up of serous ovarian tumors of low malignant potential.

The biologic behavior of serous tumors of low malignant potential (LMP) is of significant interest, yet most large series lack extended follow-up. This study consists of 200 patients: 106 patients were diagnosed with serous tumors of LMP at our institution between 1979 and 1984 and an additional 94 patients were identified in the referred tumor registry. The patients ranged in age from 6 to 98 years (median, 34 years). The stage distribution was Stage I in 135 patients (67.5%), Stage II in 24 patients (12%), and Stage III in 41 patients (20.5%). Follow-up information from 4 to 27 years (median, 10 years; mean, 11.2 years) revealed 155 patients (77.5%) were alive without further evidence of disease and 11 patients (5.5%) died of unrelated conditions without recurrent tumor. Thirty-four patients (17%) developed recurrent neoplasms at 6 to 145 months (median, 26 months). Patients with Stage III disease developed recurrent neoplasms more commonly (54%) than did patients with Stage I or II disease (6 and 17%, respectively). Following treatment of recurrence, 15 patients are free of disease, 6 patients are alive with disease, and 13 (6.5% overall) patients have died of disease 1 to 15 years (median, 5 years) after their initial diagnosis. Mortality was also stage dependent: 0.7, 4.2, and 26.8% of patients with Stages I, II, and III disease, respectively, died secondary to tumors of LMP. Clinical life table analysis demonstrated 5-, 10-, and 15-, and 20-year survival rates for all stages of 97, 95, 92, and 89%, respectively. These findings confirm the excellent prognosis for patients with serous tumors of LMP, even when long-term follow-up is extended to 20 years. Additionally, these data suggest that those with more advanced or recurrent disease can enjoy extended survival.     

Radiation treatment of advanced or recurrent granulosa cell tumor of the ovary

BACKGROUND: Because granulosa cell tumors of the ovary are rare, the optimal treatment for women with gross residual disease after primary surgery or recurrence is not known. Our objective was to review the results of radiotherapy for advanced or recurrent granulosa cell tumor of the ovary. METHODS: This retrospective review identified 34 patients with ovarian granulosa cell tumors treated with radiation at the University of Texas M. D. Anderson Cancer Center between 1949 and 1988. Fourteen received treatment for clinically measurable disease; 20 received adjuvant radiotherapy after surgery for minimal residual (<1 cm) or microscopic residual disease. The 14 patients with measurable disease formed the basis for this review. RESULTS: Ten of 14 patients were treated with moving-strip whole-abdomen radiation (27-28 Gy), 9 with 60Co, and 1 with 6-MeV photons and a pelvic boost of 28 Gy with 22-25 MeV photons. The other 4 patients were treated with pelvic radiotherapy (45-61 Gy) with 22-25 MeV photons. Six of 14 patients (43%) had a clinical complete response to radiotherapy, with a median follow-up of 13 years (range, 5-21 years). Three of 6 who responded to radiation had relapse 4-5 years later; 2 of these 3 died of disease and 1 was alive with disease at last follow-up. Three responders remain alive without evidence of disease 10-21 years after treatment. The 8 nonresponders had a median survival of 12.3 months (range, 1-60 months). CONCLUSIONS: Radiotherapy can induce a clinical response with occasional long-term remission in patients with persistent or recurrent granulosa cell tumor of the ovary.     

Prognostic factors responsible for survival in sex cord stromal tumors of the ovary--an analysis of 376 women

OBJECTIVE: To evaluate prognostic factors that impact on the survival of women with ovarian sex cord stromal tumors (SCST). METHODS: Data including age at diagnosis, stage, histology, grade, treatment, and survival were extracted from the 1988-2001 Surveillance, Epidemiology, and End Results Program. Kaplan-Meier and Cox proportional hazards analyses were used to determine the predictors for survival. RESULTS: 376 women (median age: 51) with ovarian sex cord stromal cell tumors were identified, including 339 with granulosa cell and 37 with Sertoli-Leydig cell tumors. 265 (71%) patients had stage I, 39 (10%) stage II, 40 (11%) stage III, and 32 (8%) had stage IV disease. Women with stage I-II disease had a 5-year disease-specific survival of 95% compared to 59% in those with stage III-IV cancers (p<0.001). Patients50 years (93% vs. 84%, p<0.001). This age-associated survival advantage was observed for early (97% vs. 92%, p=0.003), but not for advanced-staged (68% vs. 53%, p=0.09) patients. 110 patients with stage I-II disease underwent conservative surgery without hysterectomy. The survival for this group was similar to patients who underwent a standard surgery including a hysterectomy (94.8% and 94.9%, p=0.38). On multivariate analysis, age相似文献   

Granulosa Cell Tumor of Ovary: A Clinicopathologic and Flow Cytometric DNA Analysis

Flow cytometric DNA ploidy and S-phase fraction (SPF) analysis was performed on 18 granulosa cell tumors of the ovary. Clinical and pathologic data from patients followed for an average of 10 years were compared to flow cytometry ploidy to determine its prognostic usefulness. Eleven (62%) tumors were diploid and seven (38%) were aneuploid. Aneuploidy was significantly associated with high stage, vascular or capsular invasion, and nuclear atypia but not with SPF or necrosis. Of the patients on whom follow-up was available, only 1 of 10 (10%) with euploid tumors died of disease, while 4 of 5 (80%) with aneuploid tumors died of their disease; this, however, did not reach a significant statistical correlation. SPF was not correlated with any clinical or histologic parameter. Aneuploidy in granulosa cell tumors is associated with other adverse histopathologic parameters and an apparent trend toward aggressive behavior.     

Prognostic factors responsible for survival in sex cord stromal tumors of the ovary--a multivariate analysis

OBJECTIVE: To evaluate prognostic factors that impacts the survival of women with sex cord stromal tumors of the ovary (SCST). METHODS: Cases were identified from tumor registry databases at three academic institutions between 1975 and 2003. Patient characteristics, surgical treatment, adjuvant therapy, pathologic and follow-up information were collected from hospital charts and clinic records. Kaplan-Meier and Cox proportional hazards analyses were used to identify predictors of outcome. RESULTS: Eighty-three women (median age: 49 years) with SCST of the ovary, including 73 with granulosa and 10 with Sertoli-Leydig cell tumors were identified. Fifty-one were stage I, 8 stage II, 10 stage III, 3 stage IV, and 11 patients were unstaged. The median and 5-year disease-specific survival of women with stage I-II vs. III-IV was 180 months and 85% compared to 58 months and 48%, respectively (P = 0.012). Furthermore, age <50 (P = 0.003), premenopausal status (P = 0.013), tumor size < 10 cm (P = 0.003), lack of lymph node invasion (P < 0.0005), and absence of residual disease (P = 0.002) were all significant predictors for improved survival. Of the patients who received adjuvant treatment, chemotherapy did not impact survival (P = 0.11). Twelve of 51 stage I patients underwent fertility-sparing surgery with three recurrences. In multivariate analysis, age <50, smaller tumor size, and absence of residual disease remained as independent prognostic factors. The median follow up was 58 months (range: 1-310). CONCLUSIONS: Age <50, smaller tumor size, and absence of residual disease are important predictors for improved survival in patients with SCST of the ovary.