Wu Tzu-I, Lee Chyi-Long, Liao Pei-Ju, Huang Kuan-Gen, Chang Ting-Chang, Chou Hung-Hsueh, Wang Chin-Jung, Soong Yung-Kuei, Hsueh Swei, Lai Chyong-Huey
Department of Obstetrics and Gynecology, Chang Gung Memorial Hospital at Linkou, Chang Gung University College of Medicine, Taoyuan, Taiwan.
Chang Gung Med J. 2010 Sep-Oct;33(5):558-67.
The aim of this study was to evaluate the impact on survival of initial laparoscopic surgery compared with conventional laparotomy in stage I epithelial ovarian cancer.
We conducted a retrospective study which enrolled all consecutive patients with stage I epithelial ovarian cancer between January 1984 and December 2006. Patients with a histological diagnosis of epithelial ovarian cancer who underwent laparoscopy were recruited if their cases were compatible with stage I (clinical or surgical) at initial exploration. The independent samples t test, chi-square test, log-rank and Cox proportional hazards model were performed.
A total of 208 patients were enrolled, including 34 patients with initial laparoscopy and 174 with laparotomy. The median follow-up time for survivors was 65 (range, 2-276) months. The 5-year overall survival (OS) and recurrence-free survival (RFS) rates were 67.4% and 69.5% in the laparoscopy group, and 88.7% and 78.7% in the laparotomy group, respectively. The median time to recurrence was 14.5 (range, 2-67) months. In multivariate analysis, the initial laparoscopy approach posted significant adverse impacts on the OS (laparoscopy vs laparotomy, the hazard ratio [HR]: 3.52, p=0.009) and the RFS (laparoscopy vs laparotomy, HR: 2.58, p=0.024), while a higher substage (stage IB-IC vs IA, HR: 8.29, p=0.040) was associated with only a worse OS, and its impact on the RFS was marginal.
An initial laparoscopy intervention and higher substage posted significant adverse effects on the prognosis in stage I epithelial ovarian cancer. Important precautions when using laparoscopy for adnexal masses, such as avoiding rupture, applying protection, and submitting frozen sections, are recommended.
本研究旨在评估与传统剖腹手术相比，初始腹腔镜手术对Ⅰ期上皮性卵巢癌患者生存的影响。
我们进行了一项回顾性研究，纳入了1984年1月至2006年12月期间所有连续的Ⅰ期上皮性卵巢癌患者。组织学诊断为上皮性卵巢癌且接受腹腔镜检查的患者，若其病例在初次探查时符合Ⅰ期（临床或手术分期）则被纳入。进行了独立样本t检验、卡方检验、对数秩检验和Cox比例风险模型分析。
共纳入208例患者，其中34例初始接受腹腔镜手术，174例接受剖腹手术。存活患者的中位随访时间为65（范围2 - 276）个月。腹腔镜手术组的5年总生存率（OS）和无复发生存率（RFS）分别为67.4%和69.5%，剖腹手术组分别为88.7%和78.7%。复发的中位时间为14.5（范围2 - 67）个月。多因素分析显示，初始腹腔镜手术方式对OS（腹腔镜手术与剖腹手术相比，风险比[HR]：3.52，p = 0.009）和RFS（腹腔镜手术与剖腹手术相比，HR：2.58，p = 0.024）有显著不利影响，而较高的分期（ⅠB - ⅠC期与ⅠA期相比，HR：8.29，p = 0.040）仅与较差的OS相关，对RFS的影响较小。
初始腹腔镜手术干预和较高的分期对Ⅰ期上皮性卵巢癌的预后有显著不利影响。建议在使用腹腔镜处理附件肿块时采取重要预防措施，如避免破裂、采取保护措施和进行冰冻切片检查。
