Funt Stacey A, Hricak Hedvig, Abu-Rustum Nadeem, Mazumdar Madhu, Felderman Howard, Chi Dennis S
Department of Radiology, Memorial Sloan-Kettering Cancer Center, 1275 York Ave, New York, NY 10021, USA.
AJR Am J Roentgenol. 2004 Feb;182(2):393-8. doi: 10.2214/ajr.182.2.1820393.
The purpose of this study was to evaluate the potential role of preoperative CT in patients with recurrent ovarian cancer who undergo secondary cytoreductive surgery.
Preoperative CT examinations of 36 consecutive patients (age range, 30-75 years; mean age, 55 years) were reviewed retrospectively. Patients had recurrent ovarian cancer and secondary cytoreduction within a mean CT-surgery interval of 22 days (range, 2-69 days). The CT findings recorded were upper abdominal metastases (e.g., peritoneal carcinomatosis; perihepatic, perisplenic, gastrohepatic or gastrosplenic ligaments; gallbladder fossa; falciform ligament; lesser sac), lymphadenopathy (above or below the renal hilum), liver metastasis, large- and small-bowel obstruction, hydronephrosis, ascites, and the presence of a pelvic mass. CT findings and cancer antigen-125 (CA-125) levels were correlated with surgical resectability.
At surgery, tumors in 27 patients were optimally debulked (residual disease of <or= 1 cm) and in nine patients were nonresectable. Using multivariate analysis, hydronephrosis (odds ratio = 19.4, p = 0.03) and invasion of pelvic sidewall (odds ratio = 35.6, p = 0.006) were found to be most indicative of tumor nonresectability. The presence of small-bowel obstruction; nodal or perihepatic liver metastasis; ascites; peritoneal carcinomatosis; bladder, rectum, sigmoid colon, or vaginal involvement; or infrarenal paraaortic adenopathy; and the level of CA-125 were not strong indicators of tumor nonresectability.
In patients with recurrent ovarian carcinoma considered for secondary cytoreductive surgery, preoperative CT can be helpful in identifying the extent of the disease and can be used as an adjunct to treatment planning and management decisions.
本研究旨在评估术前CT在接受二次肿瘤细胞减灭术的复发性卵巢癌患者中的潜在作用。
回顾性分析36例连续患者（年龄范围30 - 75岁，平均年龄55岁）的术前CT检查结果。这些患者患有复发性卵巢癌，并在平均CT检查与手术间隔22天（范围2 - 69天）内接受了二次肿瘤细胞减灭术。记录的CT表现包括上腹部转移（如腹膜癌病；肝周、脾周、胃肝或胃脾韧带；胆囊窝；镰状韧带；小网膜囊）、淋巴结病（肾门上方或下方）、肝转移瘤、大肠和小肠梗阻、肾积水、腹水以及盆腔肿块的存在情况。CT表现和癌抗原125（CA - 125）水平与手术可切除性相关。
手术时，27例患者的肿瘤实现了最佳减瘤（残留病灶≤1 cm），9例患者无法切除。多因素分析显示，肾积水（优势比 = 19.4，p = 0.03）和盆腔侧壁侵犯（优势比 = 35.6，p = 0.006）最能提示肿瘤不可切除。小肠梗阻、淋巴结或肝周肝转移瘤、腹水、腹膜癌病、膀胱、直肠、乙状结肠或阴道受累、肾下主动脉旁淋巴结病以及CA - 125水平并非肿瘤不可切除的有力指标。
对于考虑接受二次肿瘤细胞减灭术的复发性卵巢癌患者，术前CT有助于确定疾病范围，并可作为治疗计划和管理决策的辅助手段。
