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卵巢低恶性潜能浆液性肿瘤(交界性肿瘤):276例患者长期(≥5年)随访的基于结局的研究

Ovarian serous tumors of low malignant potential (borderline tumors): outcome-based study of 276 patients with long-term (> or =5-year) follow-up.

作者信息

Longacre Teri A, McKenney Jesse K, Tazelaar Henry D, Kempson Richard L, Hendrickson Michael R

机构信息

Department of Pathology, Stanford University, 300 Pasateur Drive, Stanford, CA 94305, USA.

出版信息

Am J Surg Pathol. 2005 Jun;29(6):707-23. doi: 10.1097/01.pas.0000164030.82810.db.

Abstract

The natural history, classification, and nomenclature of ovarian serous tumors of low malignant potential (S-LMP) (serous tumors of borderline malignancy, atypical proliferating tumors) are controversial. To determine long-term outcome for patients with S-LMP and further evaluate whether S-LMP can be stratified into clinically benign and malignant groups, the clinicopathologic features of 276 patients with S-LMP and > or =5 year follow-up were studied. The histology of the ovarian primary, extraovarian implants, and recurrent tumor(s) were characterized using World Health Organization criteria and correlated with FIGO stage and clinical follow-up. After censoring nontumor deaths, overall survival and disease-free survival for the 276 patients was 95% (98% FIGO stage I; 91% FIGO II-IV) and 78% (87% FIGO stage I; 65% FIGO stage II-IV), respectively. Unresectable disease (P < 0.001) and invasive implants (P < 0.001) were associated with decreased survival. When compared with typical S-LMP, S-LMP with micropapillary features were more strongly associated with invasive implants (P < 0.008) and decreased overall survival (P = 0.004), but patient outcome with micropapillary S-LMP was not independent of implant type. Stromal microinvasion in the primary tumor was also correlated with adverse outcome, independent of stage of disease, micropapillary architecture, and implant type (P = 0.03). There was no association between outcome and lymph node status. Transformation to low-grade serous carcinoma occurred in 6.8% of patients at intervals of 7 to 288 months (58% > or = 60 months) and was strongly associated with increased tempo of disease and decreased survival (P < 0.001). S-LMP forms a heterogeneous group, morphologically and clinically distinct from benign serous tumors and serous carcinoma. The majority of S-LMP are clinically benign, but recurrences are not uncommon, and persistent disease as well as deaths occur. Progression to low-grade serous carcinoma is highly predictive of more aggressive disease. Other features associated with recurrent and/or progressive disease include FIGO stage, invasive implants, microinvasion in the primary tumor, and micropapillary architecture. These predictors tend to co-occur, and no single clinical or pathologic feature or combination of features identify all adverse outcomes. The small, but significant risk of progression over time to low-grade serous carcinoma emphasizes the need for prolonged follow-up in patients with S-LMP.

摘要

卵巢低恶性潜能浆液性肿瘤(S-LMP)(交界性浆液性肿瘤、非典型增生性肿瘤)的自然病史、分类及命名存在争议。为确定S-LMP患者的长期预后,并进一步评估S-LMP是否可分为临床良性和恶性组,我们研究了276例S-LMP患者的临床病理特征,并进行了≥5年的随访。根据世界卫生组织标准对卵巢原发肿瘤、卵巢外种植灶及复发性肿瘤的组织学特征进行了描述,并与国际妇产科联盟(FIGO)分期及临床随访情况进行了关联分析。在剔除非肿瘤死亡病例后,276例患者的总生存率和无病生存率分别为95%(FIGO I期为98%;FIGO II-IV期为91%)和78%(FIGO I期为87%;FIGO II-IV期为65%)。无法切除的病灶(P<0.001)和浸润性种植灶(P<0.001)与生存率降低相关。与典型的S-LMP相比,具有微乳头特征的S-LMP与浸润性种植灶(P<0.008)及总生存率降低(P=0.004)的相关性更强,但微乳头型S-LMP患者的预后并非独立于种植灶类型。原发肿瘤的间质微浸润也与不良预后相关,且独立于疾病分期、微乳头结构及种植灶类型(P=0.03)。预后与淋巴结状态无关。6.8%的患者发生了向低级别浆液性癌的转化,间隔时间为7至288个月(58%≥60个月),且与疾病进展加快及生存率降低密切相关(P<0.001)。S-LMP构成了一个异质性群体,在形态学和临床上与良性浆液性肿瘤及浆液性癌不同。大多数S-LMP在临床上是良性的,但复发并不少见,也会出现持续性疾病及死亡情况。进展为低级别浆液性癌高度提示疾病更具侵袭性。与复发和/或进展性疾病相关的其他特征包括FIGO分期、浸润性种植灶、原发肿瘤的微浸润及微乳头结构。这些预测因素往往同时出现,没有单一的临床或病理特征或特征组合能够识别所有不良预后情况。随着时间推移进展为低级别浆液性癌的风险虽小但具有统计学意义,这强调了对S-LMP患者进行长期随访的必要性。

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