Baekelandt M, Jorunn Nesbakken A, Kristensen G B, Tropé C G, Abeler V M
Department of Gynecologic Oncology, The Norwegian Radium Hospital, Oslo, Norway.
Cancer. 2000 Nov 15;89(10):2076-84.
The objective of the current study was to increase insight into the biology of fallopian tube carcinoma through an analysis of possible clinical and pathologic determinants of prognosis and to formulate recommendations with regard to a more optimal therapeutic approach for patients with this rare disease.
A study was performed of the pathology specimens and clinical case records from 151 patients with fallopian tube carcinoma who were treated consecutively. Both univariate and multivariate analyses of possible prognostic factors were performed for the whole group and for the subgroup of 41 patients with Stage I disease. The possible significance of serum CA-125 levels as a tumor marker and a marker of response to platinum-containing chemotherapy was evaluated.
In multivariate analysis, disease stage, the presence of residual tumor, and a hydrosalpinx-like appearance of the fallopian tube were of independent prognostic significance for the whole cohort. For patients with Stage I disease, the depth of infiltration in the tubal wall and intraoperative tumor rupture were of independent prognostic significance. The marked tendency of this disease for extraperitoneal spread, even in apparently early stages, was confirmed. In 37 evaluable, platinum-naïve patients, an overall response rate of 70% was obtained with platinum-based chemotherapy, with a median response duration of 12.5 months. In view of its low efficacy and high rate of serious complications, the use of postoperative radiotherapy in the treatment of patients with fallopian tube carcinoma is no longer recommended. Serum CA-125 level measurements in fallopian tube carcinoma patients have the same significance as tumor and surrogate markers of response as in ovarian carcinoma patients.
Prognostic factors in patients with early stage (Stages 0 and I) fallopian tube carcinoma seem to differ from those in patients with early stage ovarian carcinoma. For patients with more advanced stage disease, due to the striking similarities in prognostic and clinical characteristics between the two diseases, the authors recommend that the treatment and follow-up strategies for patients with ovarian carcinoma be adopted in the management of patients with fallopian tube carcinoma.
本研究的目的是通过分析预后的可能临床和病理决定因素，加深对输卵管癌生物学特性的了解，并针对这种罕见疾病的患者制定更优化治疗方法的建议。
对151例连续接受治疗的输卵管癌患者的病理标本和临床病例记录进行了研究。对整个队列以及41例I期疾病患者的亚组进行了可能预后因素的单变量和多变量分析。评估了血清CA-125水平作为肿瘤标志物以及对含铂化疗反应标志物的可能意义。
在多变量分析中，疾病分期、残留肿瘤的存在以及输卵管的输卵管积水样外观对整个队列具有独立的预后意义。对于I期疾病患者，输卵管壁的浸润深度和术中肿瘤破裂具有独立的预后意义。证实了这种疾病即使在明显早期也有明显的腹膜外扩散倾向。在37例可评估的初治铂类患者中，铂类化疗的总缓解率为70%，中位缓解持续时间为12.5个月。鉴于其疗效低和严重并发症发生率高，不再推荐在输卵管癌患者的治疗中使用术后放疗。输卵管癌患者的血清CA-125水平测量与卵巢癌患者的肿瘤标志物和反应替代标志物具有相同的意义。
早期（0期和I期）输卵管癌患者的预后因素似乎与早期卵巢癌患者不同。对于疾病分期较晚的患者，由于两种疾病在预后和临床特征上有显著相似性，作者建议在输卵管癌患者的管理中采用卵巢癌患者的治疗和随访策略。
