原发性卵巢黏液性癌的临床特征分析

目的:探讨原发性卵巢黏液性癌的临床特点,寻求恰当的治疗策略。方法:回顾分析24例卵巢黏液性癌和108例非黏液性癌患者的年龄、手术病理分期、残留病灶、化疗反应率,比较生存情况,分析影响预后的因素。结果:黏液性癌患者FIGO分期早(P=0.001)、肿瘤分级低(P=0.000)。两组患者的年龄没有差异,Ⅲ～Ⅳ期患者的手术满意率无差异(P=0.453)。黏液性癌组与非黏液性癌组初治时对紫杉醇+卡铂的化疗反应率无差异(63.2%vs 85.2%,P=0.212),黏液性癌组的耐药病例似乎与肿瘤分期、手术满意度无关,而且复发后耐药率明显升高至60%。黏液性癌组和非黏液性癌组患者的总体中位无进展生存期(PFS)(22个月vs 17个月,P=0.393)和中位总生存期(OS)(22个月vs 37.5个月,P=0.670)无差异。Ⅰ～Ⅱ期黏液性癌与非黏液性癌两组患者中位PFS(37.5个月vs 44个月,P=0.304)和OS(49个月vs 45个月,P=0.621)亦无差异。满意肿瘤细胞减灭术后的Ⅲ～Ⅳ期患者,黏液性癌组中位PFS比非黏液性癌组短(12个月vs27个月,P=0.003),中位OS也缩短(18个月vs 45个月,P=0.044);不满意肿瘤细胞减灭术后的Ⅲ～Ⅳ期患者两组中位PFS(7.5个月vs 16个月,P=0.533)和中位OS(18个月vs 33个月,P=0.192)无统计学差异。Cox多因素回归分析结果提示,影响患者无进展生存期的因素包括肿瘤病理类型、FIGO分期和手术满意度;而影响总生存期的因素只有手术满意度。结论:卵巢黏液性癌是上皮癌的一个独立类型,晚期黏液性癌患者比非黏液性癌预后差,化疗耐药可能是预后差的原因,需要筛选有效的化疗方案。

Clinical characteristics of ovarian mucinous adenocarcinoma

Objective:To summarize the clinical characteristics of primary mucinous ovarian carcinoma.Methods:A retrospective study was performed on 24 mucinous and 108 non-mucinous ovarian carcinoma patients including age,FIGO stage,residual disease,response rate to paclitaxel/platinum chemotherapy.The survival time was compared between two groups and the prognostic factors were analyzed.Results:The age was similar between two groups,while the mucinous carcinoma group had less advanced FIGO stage(P=0.001) and lower tumor grading(P=0.000).Although the overall rate of optimal debulking surgery was higher in mucinous group(P=0.020),there was no difference in advanced patients(P=0.453).Response rate to platinum-based chemotherapy was 63.2% and 85.2%,respectively(P=0.212).There seemed no relation with FIGO stage and residual disease in platium-resistant mucinous carcinoma patients,the response rate dramatically reduced to 40% in recurrent patients.The median progression-free survival(PFS) of all stages of mucinous and non-mucinous group was 22 months and 17 months(P=0.393),the median overall survival(OS) was 22 months and 37.5 months(P=0.670),respectively.While the median PFS of early stage patients was 37.5 months and 44 months(P=0.304),the median OS was 49 months and 45 months(P=0.621),respectively.The median PFS was worse in stage Ⅲ/Ⅳ mucinous carcinoma patients after optimal debulking surgery(mucinous vs non-mucinous:12 vs 27 months,P=0.003),and worse OS(mucinous vs non-mucinous:18 vs 45 months,P=0.044);but there was no difference between two groups with stage Ⅲ/Ⅳ after sub-optimal debulking surgery.Cox regression analysis showed the mucinous histology,FIGO stage and residual disease were prognostic factors for PFS,only residual tumor size was the progostic factor for OS.Conclusions:Mucinous ovarian carcinoam is an unique type in epithelial carcinoma.The prognosis was poor in advanced mucinous carcinoma patients.Cytoreductive surgery is still the first line therapy.Platinum-based chemotherapy resistance may be associated with poor prognosis,therefore new effective chemotherapy regimen should be developed.