晚期卵巢上皮性癌复发的影响因素及处理

目的 探讨晚期卵巢上皮性癌（AEOC）复发的影响因素及复发后的处理。方法 回顾分析了自1986年1月至1997年12月经系统首次治疗后复发的AEOC患者167例进行再次治疗的资料。采用Log-rank检验生存率差异,COX比例风险模型分析预后因素,logistic逐步回归法筛选影响缓解期的因素。结果 患者的中位年龄51岁（26－71岁）。60例行二次手术治疗,其中23例中残留癌直径≤1cm;107例进行再次化学药物治疗（化疗）。影响AEOC复发的因素有年龄,首次术后残留癌直径,一线化疗,先期化疗。二次肿瘤细胞减灭后残留癌直径≤1cm,残留癌直径＞1cm和化疗患者的中位生存时间分别为20,10,13个月（x^2=16.41,P=0.0003),经两两比较发现,残留癌直径≤1cm和化疗患者均比残留癌直径＞1cm患者预后好,并且残留癌直径≤1cm患者的中位生存时间明显长于化疗患者（x^2=3.97,P=0.0462)。二线化疗和未行二线化疗患者的中位生存时间分别为14,10个月,两者比较,差异有显著性（x^2=3.86,P=0.0494)。结论 年龄,首次术后残留癌直径,一线化疗,先期化疗等是影响AEOC复发的主要因素,二线化闻和二次肿瘤细胞减灭术是AEOC复发后有效的治疗手段。     

绒毛膜癌复发的影响因素分析

目的对绒毛膜癌的疗效及预后进行分析,并探讨绒毛膜癌复发的影响因素.方法对北京协和医院诊治的490例绒毛膜癌患者的临床资料进行回顾性分析.结果共有394例初治患者获得完全缓解,其中17例复发,复发率为4.3%;17例复发患者中,国际妇产科联盟（FIGO）预后评分为低危患者5例,低危复发率为2.4%（5/208）,高危患者12例,高危复发率6.5%（12/186）;巩固疗程为0个疗程、1个疗程的患者复发率分别为6.1%（3/49）、9.8%（6/61）,巩固2个疗程、3个疗程以及＞3个疗程的患者复发率分别为1.4%（1/70）、3.9%（2/51）和3.1%（5/163）;13例（76.5%,13/17）患者在3年内复发,4例3年后复发;17例复发患者经治疗后有16例（94.1%）完全缓解,其中6例（37.5%,6/16）完全缓解后再次复发,另1例部分缓解后自动出院而失访.外院治疗后复发转入我院的患者21例,共计38例复发患者,其中29例1次复发,7例2次复发,2例4次复发,总复发次数为51例次.51例次复发的治疗中,单纯使用化疗者的完全缓解率为69.2%（18/26）,再次复发率为50.0%（9/18）;化疗结合手术治疗者的完全缓解率为92.0%（23/25）,再次复发率为17.4%（4/23）.结论初治时FIGO预后评分为高危及巩固化疗不足2个疗程,是与绒毛膜癌复发明确相关的因素;3年内复发的患者占多数,但仍有3年后复发的患者;复发患者属高危人群,应积极治疗,化疗结合手术治疗是提高缓解率,降低再次复发率的重要手段.     

影响复发上皮性卵巢癌化疗疗效的临床病理因素分析

目的:分析影响铂类敏感型及耐药型复发上皮性卵巢癌(EOC)患者预后的相关临床病理因素。方法:回顾分析1985年1月至2011年11月广西医科大学附属肿瘤医院收治的复发EOC患者83例,其中铂类敏感型56例,耐药型27例。采用Kaplan-meier生存率曲线、Log-rank test检验和Cox模型多因素回归分析法分析影响复发EOC患者预后的相关因素。结果:(1)铂类敏感型复发EOC患者的中位无进展生存期(PFS)为11个月(95%CI 9.105～12.895),中位总生存期(OS)为16个月(95%CI 13.144～18.856);铂类耐药型复发EOC患者的中位PFS为8个月(95%CI 4.219～11.781),中位OS为10个月(95%CI 3.824～16.176)。(2)复发后伴有腹水、复发后化疗方案、化疗疗程、化疗效果是影响敏感型复发EOC患者的重要预后因素(P<0.05);无复发生存时间(RFS)、复发后伴有腹水、复发部位、化疗效果是影响耐药型复发EOC患者的重要预后因素(P<0.05)。(3)复发后化疗疗程数、复发后伴有腹水、化疗疗效是影响敏感型复发EOC患者预后的独立危险因素,而复发部位是影响耐药型复发EOC患者预后的独立危险因素。结论:铂类敏感型患者复发后宜选择与一线类似的铂类联合方案化疗,并尽可能化疗至6疗程。复发病灶位于盆腹腔是影响耐药型患者预后的独立危险因素,应积极治疗。     

原发性输卵管癌8例临床分析

原发性输卵管癌是一种少见的女性生殖器官恶性肿瘤，自1847年首次报道到2002年世界各地的报道约1400例。我院于2000—2005年5年间收治8例原发性输卵管癌患者，现将临床特点分析如下。     

原发性输卵管癌11例临床分析

原发性输卵管癌是罕见的女性生殖器官恶性肿瘤,平均发病率为2.9/10万～3.6/10万妇女[1].由于术前诊断困难,误诊率高,预后差,越来越引起人们的关注.     

原发性输卵管癌45例临床分析

目的:探讨原发性输卵管癌的临床表现及病理特征、诊治方法,以期提高对该病的认识.方法:回顾性分析我院2000～2010年收治的45例原发性输卵管癌患者的临床情况及诊治结果.结果:45例患者平均年龄56.9岁,30例(66.7％)为绝经后妇女.最常见的临床表现依次为盆腔肿块40例(88.9％),阴道排液13例(28.9％),腹胀10例(22.2％),腹痛9例(20.0％),异常阴道流血伴流液7例(15.6％),便秘2例(4.4％).超声检查发现40例(88.9％)有盆腔肿块;32例行血清癌抗原125( CA125)水平测定,26例(81.3％)高于35 U/ml.Ⅰ～Ⅳ期患者的5年生存比例分别为:Ⅰ期66.7％、Ⅱ期50.0％、Ⅲ期36.0％,Ⅳ期0.满意的肿瘤细胞减灭术患者较缩瘤术患者存活时间长.结论:原发性输卵管癌恶性程度高,临床表现多样且缺乏特异性,很少能在术前明确诊断.超声检查及CA125检测有助于诊断.手术是主要治疗手段.     

原发性输卵管癌8例临床误诊分析

为提高原发性输卵管癌术前诊断水平,减少误诊,我们对近6年来3所医院8例原发性输卵管癌的临床资料进行复习,结合文献对误诊原因、诊断及鉴别诊断讨论如下。1 临床资料原发性输卵管癌8例,22～65岁,平均49.5岁。其中原发不孕1例,继发不孕6例,阴道流液7例,阴道流血4例,腹痛6例,盆腔肿物7例。术前诊断为卵巢肿瘤(癌)5例,诊断为子宫肿瘤2例,诊断为阑尾炎1例。2 结 果8例均行手术治疗,其中一侧附件切除1例,一侧附件切除加阑尾切除1例,次全子宫切除加单侧附件切除1例,全子宫切除加双侧附件切除2例,全子宫切除加双侧附件切除及大网…     

原发性输卵管癌6例误诊分析并文献复习

<正>原发性输卵管癌(primary fallopian tube carcinoma,PFTC)为女性生殖系统罕见的恶性肿瘤之一,约占0.1%～1.8%[1],多数为单侧,病因尚不明确,临床表现极不典型,同时缺乏特异、可靠的化验及辅助检查手段,临床易误诊,延迟诊治,预后较差。我们复习了近3年来我院收治的6例原发性输卵管癌的临床资料,并结合文献进行分析。     

卵巢上皮性癌患者预后相关因素的分析

卵巢上皮癌（ｏｖａｒｉａｎｅｐｉｔｈｅｌｉａｌｃａｎｃｅｒ,ＯＥＣ）在女性生殖系统肿瘤中发生率居第３位,是妇科领域中患者第１位致死的疾病。ＯＥＣ占卵巢恶性肿瘤的６０％～７０％。为了探讨ＯＥＣ患者预后的相关因素,本研究对１９８４年１月至１９９３年１２月...     

Primary fallopian tube carcinoma: the Queensland experience

Abstract. Obermair A, Taylor KH, Janda M, Nicklin JL, Crandon AJ, Perrin L. Primary fallopian tube carcinoma: the Queensland experience.
The pupose of this study was to review the experience with fallopian tube carcinoma in Queensland and to compare it with previously published data. Thirty-six patients with primary fallopian tube carcinoma treated at the Queensland Gynaecological Cancer Center from 1988 to 1999 were reviewed in a retrospective clinicopathologic study. All patients had primary surgery and 31/36 received chemotherapy postoperatively. Abnormal vaginal bleeding (15/36) and abdominal pain (14/36) were the most common presenting symptoms at the time of diagnosis. Median follow-up was 70.3 months and the median overall survival was 68.1 months. Surgical stage I disease ( P = 0.02) and the absence of residual tumor after operation ( P = 0.03) were the only factors associated with improved survival. Twenty of the 36 patients (55%) presented with stage I disease and survival was 62.7% at 5 years. No patient with postoperative residual tumor survived.
The majority of the patients with fallopian tube carcinoma present with stage I disease at diagnosis, but their survival probability is low compared with that of other early stage gynecological malignancies. If primary surgical debulking cannot achieve macroscopic tumor clearence, the chance of survival is extremely low.     

Primary fallopian tube cancer: Domestic data and up-to-date review

Primary fallopian tube carcinoma (PFTC) is a rare gynecological malignancy with the following characteristics: its preoperative diagnosis is easy to miss or delay because of a lack of specific symptoms and signs; it is difficult to distinguish from serous epithelial ovarian cancer or primary peritoneal serous carcinoma during or even after operation because they have the same histopathological features; and there is uncertainty regarding the optimal management because of the lack of available standard guidelines. All of these factors contribute to the major challenge of undertaking a comprehensive study of this disease. To improve our understanding of this rare disease, the domestic data were summarized first. We searched PubMed on this topic, using the term “primary fallopian tube tumor and Taiwan” (from January 1, 1990 to November 3, 2013) and identified 15 published articles, but only 11 studies focused on the outcome of patients with PFTC in Taiwan. These limited data were not enough to increase our knowledge in dealing with this disease; therefore, the addition of large series or published review articles addressing this topic was needed. According to these reports, we concluded: (1) the main type of PFTC was serous type, often poorly differentiated; (2) the diagnosis of PFTC is frequently missed or delayed; (3) PFTC is often of an earlier International Federation of Gynecology and Obstetrics (FIGO) stage than is epithelial ovarian cancer (EOC), because of the appearance of earlier but nonspecific symptoms or signs, such as abdominal pain, vaginal bleeding, and watery discharge or mass; (4) the most important clinicopathological prognostic factor was FIGO stage; (5) the therapeutic strategy is still uncertain, but is often based on the guidelines for treating EOC. An intensive surgical effort such as a complete surgical resection or optimal cytoreduction surgery with a minimal residual tumor followed by a platinum-paclitaxel combination chemotherapy with/without targeted therapy (for example, antiangiogenesis agents) may provide the best possibility of disease-free or overall survival.     

原发性输卵管癌预后影响因素

影响原发性输卵管癌预后的因素主要有FIGO分期、手术及术后残留病灶大小、淋巴结转移情况、治疗前血CA125水平等。病理检查发现输卵管壁浸润或肿瘤位于输卵管伞端也是影响其预后的高危因素,而手术后给予紫杉醇联合铂类为主的规范化疗可提高原发性输卵管癌的远期疗效。     

Primary neuroendocrine carcinoma of the fallopian tube: a case report

Neuroendocrine carcinomas arise from Kulchitsky cells and are frequently seen in gastrointestinal tract and lungs. But they are unusual in gynecology practice. The Fallopian tube is one of the rarest locations for the development of a female genital malignancy. The most common histologic subtype is adenocarcinoma in malignancies of fallopian tubes, but rarely other histologic subtypes have been reported. Here we present a primary neuroendocrine carcinoma of the fallopian tube. To the best of the our knowledge, it was not reported previously.     

Extraperitoneal laparoscopic para-aortic lymphadenectomy for lymph node recurrence of fallopian tube carcinoma

The endoscopic retroperitoneal approach is a minimally invasive method for surgical staging of cervical cancer. A 57-year-old woman had an intraoperative diagnosis of carcinoma of the left fallopian tube and undergone a retroperitoneal pelvic and para-aortic lymphadenectomy with no peritonization during surgical staging. Small suspicious nodes in the serous membrane of the sigmoid colon and peritoneal washings were positive for malignancy. A total of 12 nodes were obtained, all of which were negative. She received six cycles of paclitaxel and platinum-based chemotherapy and showed a complete clinical response. Thirty-two months after surgery, the abdominal computed tomography scan showed a left para-aortic lymph node, 19 mm in diameter, which was successfully removed through an extraperitoneal laparoscopic approach. The extraperitoneal laparoscopic approach of the para-aortic region is a feasible procedure after previous transperitoneal lymphadenectomy and chemotherapy.     

Prognostic factors of primary fallopian tube cancer in a single institute in Taiwan

Objective

To improve the understanding of primary fallopian tube carcinoma (PFTC) through an analysis of possible clinical and pathologic determinants of prognosis.

Methods

A retrospective review of the database of a tertiary hospital in Taiwan for 1978–2007 was conducted to identify patients with a diagnosis of PFTC and to evaluate the clinicopathologic features associated with PFTC outcome.

Results

Fifty-eight patients (mean age 62.5 years) had a diagnosis of PFTC. Stage III/IV disease (55%) and poorly differentiated tumors (52%) were most common. The median follow-up was 93 months (range, 11–333 months). The 5-year disease-free survival rate was 59%, and the overall survival rate was 64%. Factors important in disease-free and overall survival in univariate analysis included the presence of pelvic and/or para-aortic lymph node metastases, International Federation of Gynecology and Obstetrics stage, high preoperative carbohydrate antigen 125 serum level, completion of optimal debulking surgery, and the use of paclitaxel-based chemotherapy; however, only patients with optimal cytoreduction had a decreased hazard of recurrence (hazard ratio [HR] 0.06; 95% confidence interval [CI] 0.01–0.23) and mortality (HR 0.08; 95% CI, 0.02–0.31) in multivariate analysis.

Conclusion

Advanced tumor stage, in particular the presence of lymph node metastases, worsened the prognosis of patients with PFTC. However, optimal debulking surgery significantly improved the prognosis, emphasizing the importance of the treatment strategy.     

Survival of patients with primary fallopian tube carcinoma

Vaughan MM, Evans BD, Weitzer MJ. Survival of patients with primary fallopian tube carcinoma. Int J Gynecol Cancer 1998; 8: 16–22.
Thirty-seven patients with primary fallopian tube carcinoma (PFTC) presenting between 1952 and 1995 were studied. The mean age was 57 years. Seven patients had stage I disease, 20 stage II, 8 stage III, and 2 stage IV. Actuarial 5-year survivals were 73% for stage I, 33% for stage II and 0% for stage III. Stage was a significant predictor of survival at 5 years (Stage I vs. III, P = 0.0006; stage II vs. III, P = 0.0001), however, the majority of patients, even with early stage disease, died of progressive PFTC within 10 years. Grade appeared highly significant at 5 and 10 years (Grades 1 & 2 vs. 3, P = 0. 0023). Neither age nor lymphocytic infiltrate appeared definitely predictive of survival. Eleven of 22 stage II patients received adjuvant treatment. While their median and 5-year survivals were superior to those not receiving adjuvant treatment (51 vs. 30 months, 47% vs. 22%), the difference was not statistically significant.
This retrospective analysis confirms the poor prognosis of patients with PFTC. The majority of patients, even with early stage tumors, eventually succumb to their disease. Larger studies may identify a group of patients potentially curable with surgery alone, and clarify the role of adjuvant therapy.     

Unexpected primary fallopian tube carcinoma during gynecological operations: Clinicopathological and prognostic factors analyses of 67 cases

ObjectiveThe aim of the study was to analyze the clinicopathologic features, the survival rate, and the prognostic factors of women with unexpected primary fallopian tube carcinoma diagnosed during gynecological operations.Materials and methodsWe reviewed medical records of patients with unexpected primary fallopian tube carcinoma at the Obstetrics and Gynecology Hospital of Fudan University between January 2004 to December 2017. The survival analysis was based on the Kaplan–Meier method, and the results were compared using the log-rank test. Cox regression analysis was used to determine factors affecting survival.ResultsSixty-seven patients with unexpected primary fallopian tube carcinoma were identified. The 5-year overall survival was 49.7%, the mean overall survival was 64 months [95% confidence interval (CI) 54–74], and the median overall survival was 59 months (95% CI 49–69). The mean follow-up time was 53.9 months (range 5–141 months). The most common clinical presentation was adnexal mass (38.8%), followed by vaginal bleeding (16.4%) and no specific symptom (13.4%). Cytoreductive surgery was performed initially in 57 (85.1%) patients. Residual disease was optimal in 56 (83.6%) patients and suboptimal in 11 (16.4%) patients. The histological subtype was predominantly the serous type (88.1%). 44 patients (65.7%) were diagnosed at Stage I/II postoperatively. 23 (34.3%) patients were in Stage III/IV. 51 patients (76.1%) had gone through laparoscopic surgery, 16 patients (23.9%) were performed laparotomy. Univariate analyses on overall survival revealed that only the International Federation of Gynecology and Obstetrics (FIGO)stage [p < 0.001; Hazard Ratio (HR), 6.433; 95% CI, 2.274–18.199], residual tumor (p = 0.014; HR, 4.957; 95% CI, 1.378–17.831) were significant prognostic factor. Pelvic lymphadenectomy did not show association with overall survival in our univariate or multivariate analyses. After an observation period of 70 months, we found an increased overall survival in the group of without lymphadenectomy.ConclusionsThe diagnosis of primary fallopian tube carcinoma is rarely considered preoperatively. The early stage and optimal debulking surgery with residual tumor ≤1 cm are important independent factors to improve patients' prognosis. However, there were no statistically significant correlations between lymphadenectomy and prognosis. The value of lymph node sampling or dissection needs to be reconsidered.     

Primary fallopian tube carcinoma

Primary fallopian tube carcinoma (PFTC) is a rare gynaecological tumour that accounts for 0.14–1.8% of genital malignancies. The most common age of occurrence is between 40 and 65 years, and the mean age is 55 years. The factors that contribute to its appearance are not well known. Population studies show that the mean incidence of PFTC is 3.6 per million women per annum. Overall survival percentages for patients with PFTC are generally low, in the range of 22–57%. Pre-operative diagnosis is rare and PFTC is usually confirmed by a pathologist, but earlier diagnosis with early clinical manifestation and prompt investigation improves the prognosis. Both PFTC and epithelial ovarian cancer (EOC) are treated with similar surgical and chemotherapy methods. Studies have shown that the prognosis for PFTC is worse than that for EOC or other primary gynaecological tumours. This article reviews and presents the current updates of this rare gynaecological malignancy.