Schilder Jeanne M, Thompson Amy M, DePriest Paul D, Ueland Frederick R, Cibull Michael L, Kryscio Richard J, Modesitt Susan C, Lu Karen H, Geisler John P, Higgins Robert V, Magtibay Paul M, Cohn David E, Powell Matthew A, Chu Christina, Stehman Frederick B, van Nagell John
Department of OB/GYN, Division of Gynecologic Oncology, Indiana University Medical Center, 535 Barnhill Drive, Rm. 436, Indianapolis, IN 46202-6294, USA.
Gynecol Oncol. 2002 Oct;87(1):1-7. doi: 10.1006/gyno.2002.6805.
The purpose of this study was to determine the recurrence rate, survival, and pregnancy outcome in patients with Stage IA and Stage IC invasive epithelial ovarian cancer treated with unilateral adnexectomy.
A multi-institutional retrospective investigation was undertaken to identify patients with Stage IA and IC epithelial ovarian cancer who were treated with fertility-sparing surgery. All patients with ovarian tumors of borderline malignancy were excluded. Long-term follow-up was obtained through tumor registries and telephone interviews. The time and sites of tumor recurrence, patient survival, and pregnancy outcomes were recorded for every patient.
Fifty two patients with Stage I epithelial ovarian cancer treated from 1965 to 2000 at 8 participating institutions were identified. Forty-two patients had Stage IA disease, and 10 had Stage IC cancers. Cell type was distributed as follows: mucinous, 25; serous, 10; endometrioid, 10; clear cell, 5; and mixed, 2. Histologic differentiation was as follows: grade 1, 38; grade 2, 9; and grade 3, 5. Twenty patients received adjuvant chemotherapy (mean 6 courses, range 3-12 courses). Patients received the following chemotherapeutic agents: cisplatin/taxol or carboplatin/taxol, 11; melphalan, 5; cisplatin and cyclophosphamide, 3; and single-agent cisplatin, 1. Eight patients had second-look laparotomies and all were negative. Duration of follow-up ranged from 6 to 426 months (median 68 months). Five patients developed tumor recurrence 8-78 months after initial surgery. Sites of recurrence were as follows: contralateral ovary, 3; peritoneum, 1; and lung, 1. Nine patients underwent subsequent hysterectomy and contralateral oophorectomy for benign disease. At present, 50 patients are alive without evidence of disease and 2 have died of disease 13 and 97 months after initial treatment. The estimated survival was 98% at 5 years and 93% at 10 years.Twenty-four patients attempted pregnancy and 17 (71%) conceived. These 17 patients had 26 term deliveries (no congenital anomalies noted) and 5 spontaneous abortions.
The long-term survival of patients with Stage IA and IC epithelial ovarian cancer treated with unilateral adnexectomy is excellent. Fertility-sparing surgery should be considered as a treatment option in women with Stage I epithelial ovarian cancer who desire further childbearing.
本研究旨在确定接受单侧附件切除术治疗的ⅠA期和ⅠC期侵袭性上皮性卵巢癌患者的复发率、生存率及妊娠结局。
开展一项多机构回顾性调查，以确定接受保留生育功能手术治疗的ⅠA期和ⅠC期上皮性卵巢癌患者。所有临界恶性卵巢肿瘤患者均被排除。通过肿瘤登记处和电话访谈进行长期随访。记录每位患者肿瘤复发的时间和部位、患者生存率及妊娠结局。
确定了1965年至2000年期间在8家参与机构接受治疗的52例Ⅰ期上皮性卵巢癌患者。42例为ⅠA期疾病，10例为ⅠC期癌症。细胞类型分布如下：黏液性25例；浆液性10例；子宫内膜样10例；透明细胞5例；混合型2例。组织学分级如下：1级38例；2级9例；3级5例。20例患者接受了辅助化疗（平均6个疗程，范围3 - 12个疗程）。患者接受的化疗药物如下：顺铂/紫杉醇或卡铂/紫杉醇11例；美法仑5例；顺铂和环磷酰胺3例；单药顺铂1例。8例患者接受了二次剖腹探查，结果均为阴性。随访时间为6至426个月（中位时间68个月）。5例患者在初次手术后8 - 78个月出现肿瘤复发。复发部位如下：对侧卵巢3例；腹膜1例；肺1例。9例患者因良性疾病随后接受了子宫切除术和对侧卵巢切除术。目前，50例患者存活且无疾病证据，2例患者在初次治疗后13个月和97个月死于疾病。5年估计生存率为98%，10年为93%。24例患者尝试妊娠，17例（71%）受孕。这17例患者有26次足月分娩（未发现先天性异常）和5次自然流产。
接受单侧附件切除术治疗的ⅠA期和ⅠC期上皮性卵巢癌患者的长期生存率良好。对于希望进一步生育的Ⅰ期上皮性卵巢癌女性，保留生育功能手术应被视为一种治疗选择。
