Wang J, Shi Y-K, Wu L-Y, Wang J-W, Yang S, Yang J-L, Zhang H-Z, Liu S-M
Departments of Medical Oncology, Cancer Institute and Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China.
Int J Gynecol Cancer. 2008 Jul-Aug;18(4):825-32. doi: 10.1111/j.1525-1438.2007.01078.x. Epub 2007 Sep 24.
The purpose of this study was to analyze prognostic factors for ovarian metastases from primary gastric cancer, helping establish optimal strategy in ameliorating survival for this entity. Clinical data of 68 consecutive patients histologically diagnosed with ovarian metastases from primary gastric cancer were accrued from 1096 cases with female gastric cancer. Metachronous surgery was performed on 36 patients and 32 received synchronous surgery. There were 14 patients treated with surgery alone and 54 with combined modality therapy. After the median follow-up time of 9.1 months, the median survival time (MST) of 12.4 months was observed for all patients. Patients treated with synchronous surgery tended to have an inferior survival compared with those treated with metachronous surgery (MST: 10.9 vs 14.3 months; P = 0.100). Combined modality showed a significantly better MST compared with surgery alone (13.6 vs 7.9 months; P = 0.004). Chemotherapy cycles (more than four or less than or equal to four) were found to have an impact on survival (MST: 14.3 vs 9.4 months; P = 0.031). Peritoneal metastases, lymphovascular involvement, and unilateral ovarian metastasectomy were independent unfavorable prognostic factors. Combined modality therapy as primary therapy resulted in good outcome, and more aggressive chemotherapy (more than four cycles) was accompanied by an improvement in survival. Innovative systemic treatments need to be explored in treatment of peritoneal metastases and lymphovascular involvement. Bilateral oophorectomy was considered when ovarian metastases were histologically diagnosed.
本研究旨在分析原发性胃癌卵巢转移的预后因素，以帮助制定改善该疾病患者生存的最佳策略。从1096例女性胃癌患者中收集了68例经组织学诊断为原发性胃癌卵巢转移的连续患者的临床资料。36例患者接受了异时性手术，32例接受了同时性手术。14例患者仅接受手术治疗，54例接受综合治疗。中位随访时间为9.1个月后，所有患者的中位生存时间（MST）为12.4个月。与接受异时性手术的患者相比，接受同时性手术的患者生存情况往往较差（MST：10.9个月对14.3个月；P = 0.100）。与单纯手术相比，综合治疗的MST明显更好（13.6个月对7.9个月；P = 0.004）。发现化疗周期（超过4个或小于或等于4个）对生存有影响（MST：14.3个月对9.4个月；P = 0.031）。腹膜转移、淋巴管浸润和单侧卵巢转移切除术是独立的不良预后因素。以综合治疗作为主要治疗方法可取得良好效果，更积极的化疗（超过4个周期）可改善生存情况。在腹膜转移和淋巴管浸润的治疗中需要探索创新的全身治疗方法。当组织学诊断为卵巢转移时，考虑进行双侧卵巢切除术。
