Le T, Krepart G V, Lotocki R J, Heywood M S
Division of Gynecologic Oncology, University of Saskatchewan, Saskatoon, Saskatchewan, S7N 0W8, Canada.
Gynecol Oncol. 1999 Aug;74(2):252-4. doi: 10.1006/gyno.1999.5440.
The role of adjuvant therapy in patients with early stage ovarian carcinoma has not been clearly defined. Most randomized trials examining this issue have not used the vigorous staging exploration accepted as today's standard. This report examines the natural history of patients after surgically documented stage 1 ovarian carcinoma followed expectantly.
A retrospective chart review was carried out using strict criteria to include only patients who had an adequate staging procedure performed by gynecologic oncologists following a fixed protocol from 1987 to 1997. Patients' demographic data as well as current disease status were abstracted and analyzed.
A total of 80 comprehensive surgical staging procedures were carried out over a 10-year period for apparent stage 1 ovarian cancer at the time of exploratory laparotomy. Fifty cases were true surgicopathological stage 1. It was found that serous and anaplastic tumors were more likely than other subtypes to be upstaged by the procedure. Further follow-up confirmed the excellent prognosis of early stage serous, endometrioid, and mucinous tumor with only one recurrence noted in an extraabdominal location in a patient with serous histology with no postoperative adjuvant therapy. Clear cell histology stands out as a significant recurrence risk (33%) despite an initially negative surgical assessment.
Careful surgical exploration can identify a group of patients with early stage epithelial ovarian carcinoma who will benefit little from further adjuvant therapy. Patients with clear cell histology prove to be at a high risk for recurrence even at an early stage such that chemotherapy should be considered.
辅助治疗在早期卵巢癌患者中的作用尚未明确界定。大多数研究此问题的随机试验并未采用当今被视为标准的严格分期探查。本报告探讨了手术记录为Ⅰ期卵巢癌且采取观察等待策略的患者的自然病程。
进行了一项回顾性病历审查，采用严格标准，仅纳入1987年至1997年按照固定方案由妇科肿瘤学家进行了充分分期手术的患者。提取并分析了患者的人口统计学数据以及当前疾病状态。
在10年期间，针对剖腹探查时看似为Ⅰ期卵巢癌的患者共进行了80例全面的手术分期。50例为真正的手术病理Ⅰ期。发现浆液性和间变性肿瘤比其他亚型更有可能在手术过程中出现分期上调。进一步随访证实，早期浆液性、子宫内膜样和黏液性肿瘤预后良好，仅1例浆液性组织学患者在未接受术后辅助治疗的情况下出现腹外复发。透明细胞组织学表现出显著的复发风险（33%），尽管最初手术评估为阴性。
仔细的手术探查可识别出一组早期上皮性卵巢癌患者，他们从进一步辅助治疗中获益甚微。透明细胞组织学的患者即使在早期也被证明复发风险很高，因此应考虑化疗。
