165例卵巢恶性肿瘤不全分期术后行再分期手术必要性的临床初探

目的 探讨卵巢上皮性癌、恶性生殖细胞肿瘤、恶性性索间质肿瘤不全分期术后行再分期手术的必要性。方法 回顾性分析2013年1月至2021年1月在郑州大学第一附属医院收治的165例不全分期中手术分期为早期（ⅠA～ⅠC期）卵巢恶性肿瘤患者行再分期手术的临床资料。其中上皮性癌组85例,恶性生殖细胞肿瘤组31例,恶性性索间质肿瘤组49例。手术获益患者定义为再分期术后手术-病理分期升高患者。结果上皮性癌组再分期手术总获益率为36.47%(31/85),明显高于生殖细胞肿瘤组（9.68%, 3/31）及性索间质肿瘤组（4.08%, 2/49）,差异有统计学意义（P <0.05）。不全分期术中医师未怀疑存在病灶残留的上皮性癌、生殖细胞肿瘤、性索间质肿瘤患者行再分期手术获益率分别为33.33%(27/81)、3.44%(1/29)及0%(0/47),均明显低于不全分期术中医师怀疑存在病灶残留者（P <0.05）;再分期术前影像学无阳性发现的上皮性癌、生殖细胞肿瘤、性索间质肿瘤患者再分期手术获益率分别为34.15%(28/82)、3.44%(1/29)及2.08%(1/48),均显著低于再分期术...     

卵巢癌再分期手术的临床意义

目的 探讨卵巢癌再分期手术的价值及其及其并发症的发生情况。方法 42例患者均为本院1986例1月至1996年1月收治的外院初次手术时未进行全面探查而诊断为Ⅰa-Ⅱa期的卵巢癌患者。其中,Ia期28例,Ⅰb期1例,Ⅰc期12例,Ⅱa期1例;卵巢上皮性癌26例,恶性生殖细胞肿瘤9例颗粒细胞肿瘤7例。外院初次手术仅行患侧附件切除术40例。结果 42例患者中12例（28.6%)患者经再分期手术证实期别提高,其中8例（19.0%)实际应为Ⅲ期患者。12例再分期手术阳性患者（指再分期手术时发现有残存肿瘤者）中,腹水或腹腔冲洗液细胞学检查有癌细胞者3例,结肠旁沟转移4例;大网膜转移2例。30例再分期手术阴性患者（指再分期手术时没有发现残存肿瘤者）中,3年和5年生存率分别为96.7%和86.7%;12例再分期手术阳性患者的3年和5年生存率分别为12例中7例和12例和12例中3例。再分期手术的主要并发症是出血（100.0%,出血量为50-1100ml,平均280ml）和淋巴囊肿(7.1%),无围手术期死亡病例。结论 对初步诊断为早期卵巢癌的患者应进行全面的分期探查手术,初次手术时未进行全面的分期探查手术者应进行再分期手术。再分期手术阴性者预后好,易于治愈。再分期手术无严重并发症。     

早期卵巢透明细胞癌再分期手术的意义

目的:探讨卵巢透明细胞癌(OCCC)再分期手术的意义及价值。方法:回顾性分析2015年2月至2019年12月北京协和医院收治的施行再分期手术的OCCC患者40例，记录患者年龄、手术方式、术中情况、再次分期手术方式、国际妇产科联盟(FIGO)分期、病理结果及随诊信息。计算并比较患者生存期及无进展生存期，预后分析采用Cox风险回归模型。结果:(1)患者初次治疗时术中情况：患者中位年龄43.5岁(22～62岁),肿瘤平均大小9.6±3.8 cm。初次手术行冰冻病理检查者18例(45.0%),其中良性病变5例，恶性病变6例，不除外恶性病变7例。初次手术行囊肿剔除术10例，附件切除术23例。术中留取腹腔冲洗液19例(47.5%),腹水瘤细胞阳性5例。(2)再分期手术及FIGO分期：初次手术与再分期手术中位间隔时间为1.35(0.5～4.1)个月，再分期术前行化疗10例(25.0%)。FIGO分期提高为Ⅱ期者1例(2.5%),提高为Ⅲ期4例(10.0%),淋巴结转移率7.5%。(3)患者随诊、预后及影响因素分析：中位随诊时间为48.6个月(5.8～87.1个月),随诊期间复发4例，复发率10.0%...     

全面手术分期对早期卵巢癌的意义

为明确卵巢癌患者手术分期的意义,比较全面手术分期或再次手术分期的结果进行回顾性研究。 研究对象1975～1999年Manitoba大学收治的76例及同期在Saskatchewan大学收治的62例卵巢癌患者。初次手术探查中肉眼见肿瘤均限于卵巢。前者于初次或再次手术中行全面手术分期,证实为Ⅰ期者予以随诊观察;而超过Ⅰ期者则给予6个周期顺铂/卡铂加环磷酰胺标准化疗。后者大     

宫颈癌的手术-病理分期和评分系统的建立和验证

目的:世界范围内大多数宫颈癌患者接受手术治疗,但目前国际妇产科联合会(FIGO)分期系统未考虑手术-病理资料。本文提出了一个更综合全面且对预后有指导价值的手术-病理分期和评分系统。方法:4220例宫颈癌队列(1)用于筛选手术-病理危险因素,构建手术-病理分期和评分系统,采用1104例宫颈癌的前瞻性研究队列(2)进行验证。结果:宫颈癌队列(1)的筛选研究中,7个独立危险因素与预后相关:淋巴结转移、宫旁浸润、病理类型、组织学分级、肿块大小、间质浸润和脉管浸润。通过纳入淋巴结转移、间质浸润和脉管浸润的附加衡量标准,FIGO分期系统被修订和扩展成为一个手术-病理分期系统。根据数量和转移部位,淋巴结转移被分为3个亚组。加入7个预后危险因素提高了评分系统实践的可行性。评分系统将患者划分为3个级别:零分、低分和高分,分别对应0分、1~3分和≥4分(P=1.08E-45;P=6.15E-55)。队列(2)的验证研究中,随着评分系统分数的升高,患者的5年总生存率和无瘤生存率减低(P=9.04E-15;P=3.23E-16)。手术-病理分期和评分系统比FIGO分期有更好的同质性和辨识力。结论:手术-病理分期和评分系统改进了对肿瘤严重程度和病灶侵袭程度的性状描述,可更精确地预测预后并指导术后治疗。     

子宫颈癌的分期及治疗

FIGO分期 目前，国际上最常使用的宫颈癌分期是FIGO于1995制定，2003年FIGO妇科肿瘤委员会对该分期进行了细微修改，见表1。     

交界性卵巢肿瘤再分期手术11例临床分析

目的:探讨交界性卵巢肿瘤再分期手术的临床价值.方法:2006年1月至2010年12月在外院初次手术未全面分期而在我院接受再分期手术的交界性卵巢肿瘤患者共11例,平均年龄34.1岁,其中ⅠA期9例,ⅠB期2例;组织学类型:浆液性交界性肿瘤7例,黏液性交界性肿瘤3例,子宫内膜样交界性肿瘤1例.结果:经过再分期手术,4例患者分期提高,包括1例黏液性交界性卵巢肿瘤,1例子宫内膜样交界性卵巢肿瘤和2例浆液性交界性卵巢肿瘤.初次手术残留肿瘤的部位为对侧卵巢1例,腹腔冲洗液中3例发现肿瘤细胞(其中1例初次手术为腹腔镜术中肿瘤破裂).再分期术后随访至今,共随访18 ～ 70个月,平均随访时间42.6个月,分期未改变的7例患者和分期提高的4例患者均无复发.结论:对于交界性卵巢肿瘤,是否再分期手术需结合患者初次手术探查的彻底性、肿瘤的组织学亚型和患者的观点综合考虑,再分期手术对于浆液性肿瘤患者可能有益.     

宫颈癌的新分期与临床意义

2009年国际妇产科联盟(FIGO)对宫颈癌分期进行了更新,2010年中国版和2011年美国国立综合癌症网络(NCCN)宫颈癌临床实践指南先后采用了FIGO的新分期.新分期中,两处做了重要更新:一是删除了0期宫颈癌(原位癌)称谓;二是根据宫颈原发肿瘤大小,将原来笼统的ⅡA期分成ⅡA1期(肿瘤直径≤4 cm)和ⅡA2期(肿瘤直径＞4 cm).     

腹腔镜在卵巢癌手术分期与治疗中的应用

腹腔镜在卵巢癌诊治中的应用目前争议较多。文章重点就腹腔镜用于卵巢癌诊断、评估、分期与补充分期手术、监测与随访等方面的现状与共识,以及腹腔镜下卵巢癌肿瘤细胞减灭术的进展和争议等问题做一阐述,希望能为临床应用与研究提供参考。     

Adjuvant and post-surgical treatment in non-epithelial ovarian cancer

Non-epithelial cancers arising from the ovary are uncommon malignancies. Germ cell tumors of the ovary arise from primordial germ cells, and sex cord-stromal tumors of the ovary represent a cluster of tumors arising from the sex cord and stromal compartment. Most patients diagnosed with germ cell tumors are young adults and adolescent females. In contrast, ovarian sex cord-stromal tumors more commonly occur in a mature age group.Advances in the adjuvant management of non-epithelial ovarian cancer following optimal surgical and pathological staging have improved patient survival outcomes. In addition, active surveillance is preferentially assigned to patients diagnosed with stage I germ cell tumor, stage 1A grade 1 immature teratoma, stage 1A yolk sac tumor, and stage 1AI sex cord-stromal tumors.This article discusses the importance of selecting the adjuvant treatment approach most suitable to the patients' surgical and pathological stages, thereby safeguarding patient outcomes.     

Lymph-node metastasis in stage I and II sex cord stromal and malignant germ cell tumours of the ovary: A systematic review

Objectives

The aim of this systematic review is to determine the incidence of lymph-node metastasis in clinical stage I and II sex cord stromal tumours and germ cell tumours of the ovary.

Methods

Relevant articles were identified from MEDLINE and EMBASE and supplemented with citations from the reference lists of the primary studies. Eligibility was determined by two authors. Included studies were prospective or retrospective cohort and cross-sectional studies analysing at least ten patients with clinical early-stage non-epithelial ovarian cancer who underwent lymphadenectomy or lymph-node sampling as part of a staging laparotomy.

Results

For sex cord stromal tumours, five articles including 578 patients were analysed and lymph-node metastasis was not detected in the 86 patients who underwent lymph-node removal. The median number of removed lymph nodes was 13 (range 9–29).For malignant germ cell tumours, three articles were eligible including 2436 patients of whom 946 patients underwent lymph-node resection. The mean number of removed nodes was 10 (range 2–14) with a mean incidence of lymph-node metastasis of 10.9% (range 10.5–11.8%).

Conclusions

The incidence of lymph-node metastasis in patients with clinical stage I and II sex cord stromal tumours is low, whereas the incidence in patients with clinical stage I–II germ cell tumours is considerable, although limited data are available.     

Ovarian cancer in pregnancy: a clinicopathologic analysis of 22 cases and review of the literature

Abstract.   Zhao XY, Huang HF, Lian LJ, Lang JH. Ovarian cancer in pregnancy: a clinicopathologic analysis of 22 cases and review of the literature. Int J Gynecol Cancer 2006; 16: 8–15.
The aim of this study was to summarize our experience of ovarian cancer diagnosed during pregnancy, to review the literature concerned, and to discuss the rationale for therapy. Twenty-two patients of ovarian malignancies complicating pregnancy were treated at Peking Union Medical College Hospital between 1985 and 2003. Data on treatment and follow-up were reviewed, and their outcomes were analyzed by survival analysis. The incidence of ovarian carcinoma complicating pregnancy in the series was 0.073/1000 pregnancies. Nine (40.9%) were found with ovarian malignant germ cell tumors, six (27.3%) with low malignant potential tumors, five (22.7%) with invasive epithelial tumors, and two (9.1%) with sex cord stromal tumors. Sixteen (72.7%) of the patients were diagnosed in stage I and had achieved complete remission. Four of the five in advanced stage died. Ascites presenting at diagnosis implies advanced disease and gloomy prognosis. The mean follow-up was 47.8 months. The prognosis was significantly related with stage and histologic type ( P < 0.05). Thirteen healthy live babies were recorded in this group, and one premature newborn died of respiratory distress syndrome. The clinical characters and prognosis of ovarian cancers complicating pregnancy are similar to those of nonpregnant, reproductive-age women. Management depends on histology of the tumor, stage of the tumor, and the term of the pregnancy. In most of cases, conservative surgical treatment could be performed with adequate staging and debulking equal to the treatment of nonpregnant women. Chemotherapy is not contraindicated during the second or third trimester, but the choice of couple must be considered.     

卵巢肿瘤2 668例分类及发病特点分析

目的了解卵巢肿瘤发病特点及其发病规律，为医疗决策提供依据。方法回顾性描述1951年-2000年我院收治的2668例卵巢肿瘤发病情况。结果各型卵巢肿瘤例数随年代进展逐年增加，各年代以表面上皮一间质肿瘤和生殖细胞肿瘤最多，两者构成比之和均达到85％以上，其次为性索间质肿瘤、继发性肿瘤等；不同发病年龄组各类卵巢肿瘤构成比仍以表面上皮一间质肿瘤和生殖细胞肿瘤最多，两者构成比之和均达到77％以上，其中恶性肿瘤以41～60岁发病年龄组较多，交界瘤以21～50岁发病年龄组较多。结论鉴于各类卵巢肿瘤发病人数日趋升高，临床应对其引起高度重视；各类卵巢肿瘤具有不同的发病年龄特征，为正确诊治提供参考。     

Analysis of serum CA125, CEA, AFP, LDH levels and LDH isoenzymes in patients with ovarian tumors--correlation between tumor markers and histological types of ovarian tumors

Serum CA125, CEA, AFP, LDH levels and LDH isoenzymes were analyzed in ovarian tumor patients, who were treated at Kyoto University Hospital. CA125 was positive in 10/16 (62.5%) cases of common epithelial carcinoma, especially 100% positive in serous carcinoma, but was negative in mucinous tumors. CA125 was also negative in patients with germ cell and sex cord stromal tumors. CEA was positive in 13/32 (40.6%) cases of epithelial carcinoma, most frequently elevated in patients with mucinous carcinoma, pseudomyxoma peritonei, and Krukenberg tumor. AFP was positive only in those with endodermal sinus tumors. LDH was elevated in 16/39 (41%) cases of epithelial carcinoma, but was not specific for histological types. In contrast, all 8 cases of dysgerminoma, 1 of immature teratoma and 2 of endodermal sinus tumor showed extremely elevated LDH levels. Moreover, the normal pattern or deviation to H subunit of LDH isoenzymes was seen in such cases of germ cell tumor, while deviation to M subunit was noted in epithelial and metastatic tumor patients. These data indicate that each parameter is useful as a tumor marker for the specific histological type of ovarian tumor; CA125 for non-mucinous epithelial carcinoma, CEA for mucinous tumor and Krukenberg tumor, AFP for yolk sac tumor, LDH and LDH isoenzymes for dysgerminoma and other solid germ cell tumors. In addition, preoperative diagnosis of histological types of ovarian tumors may be possible by combining these tumor markers.     

Ovarian cancer during pregnancy

Objective

To evaluate the clinical features, pregnancy outcome, and treatment of patients with ovarian cancer diagnosed during pregnancy.

Methods

The present study was a retrospective review of 11 cases of ovarian cancer detected during pregnancy. The women were treated and followed up at Selçuk University, Meram Faculty of Medicine, Konya, Turkey, during 2006–2010.

Results

Approximately half the patients were asymptomatic (5 [45.5%]) and diagnosed during cesarean delivery (6 [54.5%]). The histopathologic tumor categories comprised malignant epithelial ovarian tumor (4 [36.4%]), borderline tumor (4 [36.4%]), malignant germ cell tumor (2 [18.2%]), and sex cord stromal tumor (1 [9.1%]). Nine (81.8%) tumors were classified as stage I. Conservative surgery was performed in 10 (90.9%) patients. A patient with stage IIIC serous papillary adenocarcinoma underwent hysterectomy with bilateral salpingo-oophorectomy. A patient with dysgerminoma in stage IV died on follow-up. Three infants were born premature; they were followed up in the neonatal intensive care unit with satisfactory outcomes.

Conclusion

Early diagnosis and appropriate treatment are crucial for patients with ovarian cancer diagnosed during pregnancy. Tumor staging is possible during pregnancy, but the appropriateness of surgery needs to be considered carefully. Ideally, the treatment strategy should be discussed and structured on an individual basis.     

Malignant germ cell tumors of the ovary

OBJECTIVE: To evaluate the efficacy of adjuvant therapy for ovarian germ cell tumors. METHODS: We reviewed records of women who had malignant germ cell tumors of the ovary from 1977-1997. RESULTS: Seventy-two women had surgical resections of malignant ovarian germ cell tumors and most received adjuvant therapy. Fifty-six women (78%) presented with stage I disease, and 16 (22%) had more advanced disease. Tumor subtypes included dysgerminoma (n = 20), yolk sac tumor (n = 8), immature teratoma (n = 29) and mixed germ cell tumor (n = 15). Surgical management of the 56 with stage I disease consisted of total abdominal hysterectomy, bilateral salpingo-oophorectomy, and extensive surgical staging in ten women, whereas a conservative surgical approach, consisting of unilateral adnexectomy with or without comprehensive surgical staging, was adopted in later years (n = 46). Fifty-six women were treated with postoperative chemotherapy, predominantly platinum-based regimens. The 5-year actuarial survival rate was 93%. None of the 36 women who presented after 1984 have died of disease. CONCLUSION: These data confirmed that platinum-based adjuvant treatments allow most women with ovarian germ cell malignancies to have conservative surgery without compromising survival.     

卵巢恶性肿瘤与血小板增多关系的临床研究

目的 :探讨卵巢恶性肿瘤伴发血小板增多的临床规律及病理特点。方法 :回顾分析 2 2 7例卵巢恶性肿瘤患者的临床及病理资料 ,4 8例合并血小板增多。结果 :血小板增多的患者中 >4 0岁者超过 80 % ;血小板增多的卵巢恶性肿瘤患者占卵巢恶性肿瘤患者的 2 1.15 % ,其中晚期 (Ⅲ期 +Ⅳ期 )患者占 80 %以上。病理类型 :4 8例中 ,卵巢上皮癌38例 ,生殖细胞恶性肿瘤 5例 ,性索间质肿瘤 3例 ,转移性恶性肿瘤 2例 ;卵巢上皮性癌中血小板增多的发生率为 2 5 .33% ,所有患者均经有效治疗 ,治疗后血小板计数下降。结论 :卵巢恶性肿瘤伴发血小板增多 ,以上皮性癌占多数 ,晚期患者多见 ,预后差。血小板增多常提示有隐匿的恶性肿瘤存在。     

Is complete surgical staging necessary in patients with stage I mucinous epithelial ovarian tumors?

OBJECTIVE: To evaluate the impact on prognosis of complete surgical staging in patients with stage I mucinous epithelial ovarian tumors. METHODS: We retrospectively reviewed the medical records of all patients with stage I mucinous epithelial tumors apparently confined to ovaries treated in the Department of Obstetrics and Gynecology, Asan Medical Center, from 1990 through 2005. RESULTS: Of 264 patients treated during this time period, 62 (23.5%) had complete and 202 (76.5%) had incomplete initial surgical staging. No patient with clinically apparent stage I borderline tumor was upstaged, 5 of 85 patients with invasive mucinous cancer was upstaged due to positive peritoneal cytology and there was no upstaged patient owing to occult lymph node metastasis. No recurrence was observed in the completely staged and 2 (1.4%) in the incompletely staged group among the patients with borderline tumor developed relapse. Three (11.5%) recurrences in the completely staged and four (6.8%) in the incompletely staged group among the patients with invasive cancer were observed, and the difference was not statistically significant. We also observed no significant differences between two groups in progression-free survival and overall survival. CONCLUSION: Complete surgical staging could probably be omitted in patients with stage I mucinous epithelial tumors.