88例卵巢透明细胞癌临床及预后分析

目的分析卵巢透明细胞癌的临床病理特点,探讨更有效的治疗方法和影响预后的因素。方法回顾性分析1984年1月至2005年5月收治的88例卵巢透明细胞癌患者的临床及随访资料。结果(1)43例患者术后给予以铂类为主的联合化疗,有效率为35.0%,复发率为67.4%,3、5年生存率分别为43.9%和29.3%;33例患者给予紫杉醇(PTX)联合铂类化疗,有效率为73.9%,复发率为45.5%,3、5年生存率分别为57.3%和40.5%;12例患者给予开普拓(CPT-11) 丝裂霉素(MMC)联合化疗,有效率为71.4%,复发率为25.0%,3年生存率为70.7%。(2)88例患者中,复发47例,复发率为53.4%。Ⅰ期患者总的复发率(45.4%)明显低于Ⅱ Ⅲ期患者(75.0%);Ⅰ期行淋巴结清扫术患者的复发率(27.8%)明显低于未行淋巴结清扫术者(51.3%);CA125升高患者的复发率(67.3%)明显高于CA125正常或不详者(38.1%)。(3)88例患者总的3、5年生存率分别为48.7%和40.9%。Ⅰ期患者总的3、5年生存率明显高于Ⅱ Ⅲ期患者(P<0.05);Ⅰ期行淋巴结清扫术患者的3、5年生存率明显高于未行淋巴结清扫术者(P<0.05);Ⅲ期术后残存肿瘤<2cm患者的3、5年生存率明显高于残存肿瘤≥2 cm的患者(P<0.05);CA125升高患者的3、5年生存率与CA125正常或不详者的差异无统计学意义(P>0.05)。结论卵巢透明细胞癌的预后较差,对以铂类为主的联合化疗可能更耐药;临床分期、是否行淋巴结清扫术以及化疗方案的选择等因素可能会影响预后。

Prognostic analysis of 88 patients with ovarian clear cell carcinoma

OBJECTIVE: To investigate the clinical characteristics of clear cell carcinoma of the ovary and to compare the survival of the patients treated by three different chemotherapy regimens. METHODS: Between 1984 and 2005, the clinical data of 88 surgically treated patients with clear cell carcinoma of the ovary were retrospectively analyzed. Of the 88 patients, 55 (62.5%) had tumor in stage I, 2 in stage II, 22 in stage II, 3 in stage IV and 6 in indefinite stage. These patients underwent either bilateral salpingo-oophorectomy with hysterectomy and omemtectomy or cytoreduction surgery. Of 55 stage I patients, 20 received pelvic lymohadenectomy. All patients were given postoperative chemotherapy, 43 patients received CAP/CP, 33 paclitaxel combination with carboplatinum/cisplatin (TC/TP) and 12 CPT-11 plus MMC. RESULTS: The response rate, recurrence rate, 3- and 5-year survival was 35.0%, 30.2% (13/43), 67.4% (29/43), 43.9% and 29.3%, respectively in patients treated with CAP/CP; 73.9%, 18.2% (6/33), 45.5% (15/33), 57.3% and 40.5%, respectively in the patients with TC/TP; 71.4%, 16.7% (2/12), 25.0% (3/12), 70.7% ( 3-yr survival, no available 5-yr survival), respectively in the patients with CPT-11 + MMC (P < 0.05). During follow-up, 47 (53.4%) patients were found to have recurrence, it was 45.4% (25/55) in stage I patients including 29.6% (8/27) in stage I a + I b and 60.7% (17/28) in stage I c, 75.0% (18/24) in stage II + III and 4/6 in the indefinite FIGO stage. The recurrences rate was 27.8% (5/18) in stage I patients with pelvic lymphadenectomy vs. 51.3% (19/37) in those without. It was 67.3% in 46 patients with elevated CA125, and 38.1% in the other 42 patients with normal or unavailable CA125 (P < 0.05). The overall 3- and 5-year survival rate of 88 patients was 48.7% and 40.9% , respectively, with 72.5% and 66.8% in stage I, 100.0% and 70.5% in stage Ia + Ib, 68.5% and 60.3% in stage Ic, 41.8% and 20.8% in stage II + III, 0 in stage IV (P < 0.05). The 3- and 5-year survival in stage I with pelvic lymphadenectomy was 88.5% and 75.8% vs. 70.3% and 65.1% in those without (P < 0.05). The 3- and 5-year survival of the patients with optimal (residual disease less than 2 cm) was 36.7% and 23.1% vs. 22.2% and 0 in those with suboptimal cytoreduction (P < 0.05), it was 46.8% and 38.8% in the patients with elevated CA125 vs. 46.7% and 43.5% in those with normal one (P > 0.05). CONCLUSION: Our data show that ovarian clear cell cancer patient have a poor response to CAP/CP and may have a better response to TC/TP, especially to CPT-11 plus MMC. However, the overall prognosis is still poor and further clinical investigations are needed to improve it.