以转移灶症状为首发症状的卵巢上皮性癌

目的 探讨以转移灶症状为首发症状就诊的卵巢上皮性癌（EOC)的临床特点、治疗和预后。方法 自1986年1月－1997年12月我院收25例盆腔病灶隐匿、最初表现均为远处转移灶症状的EOC患者,回顾性分析其临床资料。结果 首发症状为锁骨上和腹股沟淋巴结转移者最多见,分别为6例和5例;2个以上部位转移者6例。16例（64％）术后盆腹腔残留灶直径≤1cm。20例Ⅳ期患者的中位生存时间为24个月;仅有有上淋巴结或胸膜转移者中位生存时间为30个月,明显高于其他部位转移患者的19个月（P＝0．0264）。结论 以转移灶症状为首发症状就诊的EOC预后较好,特别是仅有锁骨上淋巴结或胸膜转移者,不应放弃积极的手术和化学治疗。

Ovarian carcinoma presents as distant metastases without detectable tumors of the origin disease at the first presentation

OBJECTIVE: To study the characteristics, therapies and prognosis of the patients with epithelial ovarian cancer (EOC) that are initially categorized as extra-abdominal adenocarcinoma of unknown primary. METHODS: Twenty-five patients with EOC, who were treated in the Cancer Hospital of Fudan University from Jan. 1986 to Dec. 1997, and manifesting as extra-peritoneal or liver parenchyma metastases at the time of presentation, without detectable ovarian tumors, were retrospectively studied. RESULTS: Supraclavicular and inguinal lymph node metastases were common in this group of patients, with 6 and 5 cases respectively, and 6 patients with more than two sites metastases simultaneously. 16 patients (64%) were optimally surgical debulked. 20 patients with stage IV EOC initially presenting as extra-abdominal metastases experienced a better prognosis, with an estimated median survival of 24 months. Of whom the median survival was 30 months in patients presenting with pleural effusion or supraclavicular lymph node metastases Vs. 19 months in those with other sites spread (P = 0.0264). CONCLUSIONS: The prognosis of such cases, particularly for those with supraclavicular lymphadenopathy or malignant pleural effusion, is a lot better than other stage IV EOC patients, probably because of most of the patients initially presenting with distant metastases being generally in a good condition competent for aggressive surgery or multi-cycle chemotherapy.