Rao Gautam G, Skinner Elizabeth, Gehrig Paola A, Duska Linda R, Coleman Robert L, Schorge John O
Department of Obstetrics and Gynecology, University of Texas Southwestern Medical Center, Dallas, Texas, USA.
Obstet Gynecol. 2004 Aug;104(2):261-6. doi: 10.1097/01.AOG.0000133484.92629.88.
Women diagnosed with ovarian tumors of low malignant potential have an excellent prognosis. Because few will receive adjuvant therapy, the benefit of surgical staging has recently been challenged. The purpose of this study was to compare the outcome of surgically staged patients with low malignant potential tumors with those who were not staged.
Between 1984 and 2003, all women with ovarian low malignant potential tumors were identified at 3 institutions. Data were extracted from clinical records.
One hundred eighty-three (74%) of 248 women were surgically staged. Forty of 183 staged patients had clinically obvious extraovarian disease. Forty (28%) of the remaining 143 women with disease apparently confined to the ovary were upstaged. Cytologic washings were positive in 28 cases, 10 had microscopic implants detected by peritoneal or omental biopsy, and 2 were upstaged to stage IIIC solely on the basis of nodal metastases. One hundred eighteen women underwent pelvic node dissection (median: 5 nodes), and 86 underwent para-aortic node dissection (median: 2 nodes). Overall, 9 (1%) metastases were detected in 832 submitted pelvic nodes. All 314 para-aortic nodes were negative. Intraoperative blood loss (P <.001) and length of hospital stay (P <.001) were increased in women without gross disease who were surgically staged. Eight (3%) of 248 patients received adjuvant platinum-based chemotherapy, but neither of the women upstaged to IIIC based on the results of their nodal dissection were treated. Fifteen (6%) recurrences developed and 1 (0.4%) death occurred after a median follow-up of 28 (range, 1-208) months.
Routine pelvic and para-aortic lymph node dissection is not necessary in the majority of women with ovarian low malignant potential tumors.
被诊断为低恶性潜能卵巢肿瘤的女性预后良好。由于很少有人会接受辅助治疗，手术分期的益处最近受到了质疑。本研究的目的是比较接受手术分期的低恶性潜能肿瘤患者与未分期患者的结局。
1984年至2003年间，在3家机构识别出所有患有卵巢低恶性潜能肿瘤的女性。数据从临床记录中提取。
248名女性中有183名（74%）接受了手术分期。183名分期患者中有40名有临床上明显的卵巢外疾病。其余143名疾病显然局限于卵巢的女性中有40名（28%）被上调分期。细胞学冲洗液在28例中呈阳性，10例通过腹膜或网膜活检检测到微小种植灶，2例仅基于淋巴结转移被上调至IIIC期。118名女性接受了盆腔淋巴结清扫（中位数：5个淋巴结），86名接受了腹主动脉旁淋巴结清扫（中位数：2个淋巴结）。总体而言，在送检的832个盆腔淋巴结中检测到9个（1%）转移灶。所有314个腹主动脉旁淋巴结均为阴性。在无肉眼可见疾病且接受手术分期的女性中，术中失血量（P<.００１）和住院时间（P<.００１）增加。248例患者中有8例（3%）接受了以铂类为基础的辅助化疗，但根据淋巴结清扫结果被上调至IIIC期的两名女性均未接受治疗。中位随访28（范围1-208）个月后，出现15例（6%）复发，1例（0.4%）死亡。
对于大多数患有卵巢低恶性潜能肿瘤的女性，常规盆腔和腹主动脉旁淋巴结清扫没有必要。
