Abu-Rustum Nadeem R, Restivo Antonella, Ivy Joseph, Soslow Robert, Sabbatini Paul, Sonoda Yukio, Barakat Richard R, Chi Dennis S
Gynecology Service, Department of Surgery, Memorial Sloan-Kettering Cancer Center, 1275 York Avenue, Room C-1096, New York, NY 10021, USA.
Gynecol Oncol. 2006 Oct;103(1):31-4. doi: 10.1016/j.ygyno.2006.01.050. Epub 2006 Mar 13.
To describe the incidence of retroperitoneal pelvic or paraaortic lymph node metastasis in patients with primary and recurrent ovarian granulosa cell tumors.
At Memorial Sloan-Kettering Cancer Center, we conducted a retrospective chart review of all patients with ovarian granulosa cell tumors managed as inpatients from January 1991 to July 2005. The initial date of diagnosis ranged from 1971 to 2005.
We identified 68 patients with a median age of 49 years (mean, 47.5 years; range, 19-78 years). Sixty-four (94%) patients had adult type and 4 (6%) had juvenile granulosa cell tumors. Fifty-three (78%) patients had their initial surgery at another institution and 55 (81%) were incompletely surgically staged at diagnosis due to the absence of pelvic and/or aortic lymph node dissection. Patients were assigned an International Federation of Gynecology and Obstetrics (FIGO) stage that included IA, 39; IC, 15; IIB, 3; IIC, 3; IIIC, 1. In 7 patients, the original stage was not assigned. Only 16 (24%) patients had a pelvic lymph node sampling and 13 (19%) also had a paraaortic lymph node sampling at primary surgery or at restaging surgery performed shortly following initial diagnosis; however, in these cases, lymph nodes were negative for metastasis. The median number of pelvic lymph nodes removed was 10 (mean, 11.6 nodes; range, 0-36 nodes). The median number of paraaortic lymph nodes removed was 4 (mean, 6 nodes; range, 0-19 nodes). Nine of 15 (60%) of patients managed initially at our institution were surgically staged compared to 4 of 53 (7.5%) who were managed initially elsewhere (P < 0.001). Thirty-four patients with recurrent granulosa cell tumors were managed during the study, 31 (91%) had adult type granulosa cell tumor, and 3 had juvenile histology. Thirty-three of 34 patients who recurred were incompletely surgically staged at the initial operation. Original "clinical" FIGO stage for patients who recurred included IA, 15; IC, 8; IIB, 1; IIC, 3; IIIC, 1; and in 6 patients, the original stage was not available. The median disease-free interval to first recurrence was 63 months (mean,69.4 months; range, 4-170 months). First recurrence sites included pelvis, 24/34 (70%); pelvis and abdomen, 3 (9%); retroperitoneum only, 2 (6%); pelvis and retroperitoneum, 2 (6%); pelvis/abdomen/retroperitoneum, 1(3%); abdomen only, 1 (3%); and bone, 1 (3%).
Complete surgical staging was performed in approximately 1/5 women with ovarian granulosa cell tumors; however, in those initially surgically staged, no nodal metastasis was identified. Clinical stage IA disease was the most common original diagnosis in women who recurred, and approximately 15% of first recurrences appear to involve the retroperitoneum.
描述原发性和复发性卵巢颗粒细胞瘤患者腹膜后盆腔或腹主动脉旁淋巴结转移的发生率。
在纪念斯隆凯特琳癌症中心，我们对1991年1月至2005年7月期间所有住院治疗的卵巢颗粒细胞瘤患者进行了回顾性病历审查。初次诊断日期为1971年至2005年。
我们确定了68例患者，中位年龄为49岁（平均47.5岁；范围19 - 78岁）。64例（94%）患者为成人型，4例（6%）为青少年颗粒细胞瘤。53例（78%）患者在其他机构接受了初次手术，55例（81%）患者在诊断时由于未进行盆腔和/或主动脉旁淋巴结清扫而手术分期不完全。患者被分配国际妇产科联盟（FIGO）分期包括IA期39例；IC期15例；IIB期3例；IIC期3例；IIIC期1例；7例患者未分配原始分期。仅16例（24%）患者在初次手术或初次诊断后不久进行的再次分期手术中进行了盆腔淋巴结采样，13例（19%）还进行了腹主动脉旁淋巴结采样；然而，在这些病例中，淋巴结转移均为阴性。切除的盆腔淋巴结中位数为10个（平均11.6个；范围0 - 36个）；切除的腹主动脉旁淋巴结中位数为4个（平均6个；范围0 - 19个）。在我们机构最初接受治疗的15例患者中有9例（60%）进行了手术分期；相比之下，最初在其他地方接受治疗的53例患者中有4例（7.5%）进行了手术分期（P < 0.001）。在研究期间对34例复发性颗粒细胞瘤患者进行了治疗，其中31例（91%）为成人型颗粒细胞瘤，3例为青少年组织学类型肿瘤。34例复发患者中有33例在初次手术时手术分期不完全。复发患者最初的“临床”FIGO分期包括IA期15例；IC期8例；IIB期1例；IIC期3例；IIIC期1例；6例患者无法获得原始分期。首次复发的中位无病间期为63个月（平均69.4个月；范围4 - 170个月）。首次复发部位包括盆腔24/34例（70%）；盆腔和腹部3例（9%）；仅腹膜后2例（6%）；盆腔和腹膜后2例（6%）；盆腔/腹部/腹膜后1例（3%）；仅腹部1例（3%）；骨骼1例（3%）。
约五分之一的卵巢颗粒细胞瘤女性患者进行了完整的手术分期；然而，在那些最初进行手术分期的患者中，未发现淋巴结转移。临床IA期疾病是复发女性患者最常见的初始诊断，约15%的首次复发似乎累及腹膜后。
