30岁以下卵巢上皮性癌患者21例临床分析

目的探讨年轻卵巢上皮性癌患者的临床表现、病理类型、手术病理分期、治疗及预后。方法回顾性分析1986年1月至2002年3月间在我院治疗、年龄<30岁的卵巢上皮性癌21例患者的临床资料。结果21例患者确诊为卵巢上皮性癌时的中位数年龄为24岁(16～29岁),占同期全体卵巢上皮性癌患者的4.99%(21/421)。21例均在月经初潮后发病。12例有各种症状,腹痛8例、腹胀4例、月经改变3例等。21例中,急诊手术5例,16例为择期手术。肿物最大径线平均为17.6cm。16例肿瘤为单侧,4例为双侧,1例不详。手术病理分期,Ⅰ期10例、Ⅲ期5例、分期不详6例。病理类型以黏液性乳头状囊腺癌(9例)和浆液性乳头状囊腺癌(6例)最多见。病理分化程度,除6例不详外,高分化11例,中分化2例,低分化2例。初治时行肿瘤细胞减灭术或分期手术15例,复发后行再次肿瘤细胞减灭术6例;除2例患者外,肿瘤均切除干净或基本切除干净。共8例患者保留了生育功能。18例患者进行了以铂类或紫杉醇为基础药物的联合化疗,其中7例化疗达6个疗程以上。平均随访50个月(2～192个月)。结果6例患者死亡,2例带瘤生存,11例无瘤生存,2例失访。3年生存率为89%,5年生存率为76%。结论30岁以下妇女患卵巢上皮性癌较罕见,患者于月经初潮后发病,肿瘤体积较大,单侧多见;临床手术病理分期早期、病理分化程度高分化,病理类型以黏液性囊腺癌为多见,经手术及化疗,预后相对较好。

Analysis of 21 cases of epithelial ovarian malignancies in women aged below 30 years

OBJECTIVE: To study the presentation, histology type, stage of disease, treatment and outcome of epithelial ovarian malignancies in young women less than 30 years old. METHOD: A total of 21 cases of epithelial ovarian malignancies in young women less than 30 years old between Jan 1986 and Mar 2002 were analyzed retrospectively. RESULTS: The median age at the time of diagnosis was 24 years (range 16-29 years). All carcinomas occurred after menarche. The most common presenting symptoms were abdominal pain (50%), followed by tympanites (25%) and dysmenorrhea (19%), and the initial diagnosis was usually made based on physical examination, ultrasonography and serum CA(125). The mean maximal tumor diameter was 17.6 cm. Ten (67%) patients had stage I disease (5 Ia, 5 Ic), and 5 (33%) had stage III disease at the time of diagnosis; 43% were mucinous tumors, and 29% serous ones. Most tumors were well-differentiated ones classified as grade 1, 73%, others were grade 2, 13%, and grade 3, 13%. Optimal cytoreduction was achieved in 93% (14/15) of patients in primary treatment and 83% (5/6) in recurrence treatment. Eight patients were treated with conservative surgery, and 18 patients with chemotherapy, of which 7 patients had more than six courses of chemotherapy. The median follow-up was 50 months (range, 2-192 months). Six patients died in this series, 2 were alive with tumor, 11 alive free of tumor, and two were lost in follow-up. The 3-year and 5-year survival rate was 89%, and 76%, respectively. CONCLUSION: Young patients with epithelial ovarian carcinoma appear to have favorable stage and histologic grade and good survival.