Department of Obstetrics and Gynecology, College of Medicine, University of Ulsan, Asan Medical Center, Seoul, Korea.
Ann Surg Oncol. 2011 Nov;18(12):3462-8. doi: 10.1245/s10434-011-1752-x. Epub 2011 May 10.
The purpose of this study was to assess clinical outcomes with respect to the extent of stromal invasion in patients with stage I ovarian mucinous adenocarcinoma (MAC) of the intestinal type.
We retrospectively reviewed the medical records and pathologic slides of 113 patients with stage I ovarian MACs who were treated at the Asan Medical Center from January 1994 to July 2009. According to the recent histopathologic criteria, MACs were classified into 3 groups: intraepithelial carcinoma without invasion (IEC), intraepithelial carcinoma with microinvasion (IECMI), and mucinous adenocarcinoma with extensive invasion (MACEI). Stromal invasion was confined to the tumors showing severe cytologic atypia in the invasive foci. Therefore, cases showing mucin granulomas composed only of macrophages without malignant cells were excluded from the definition of invasion.
Of the 113 patients, 54 (47.8%) had IEC, 15 (13.3%) had IECMI, and 44 (38.9%) had MACEI. There were no differences among groups in age, menopausal status, CA-125 level, surgical procedures, stage, capsular and lymphovascular space invasion. The 5-year disease-free-survival rates in the IEC, IECMI, and MACEI groups were 97.7%, 77.3%, and 79.9%, respectively (IEC vs IECMI, P=0.004; IEC vs MACEI, P=0.012; IECMI vs MACEI, P=0.555). Prognosis was significantly poorer for patients with IECMI than for those with IEC, but not different between patients with IECMI and MACEI.
Stromal microinvasion in ovarian MAC is a significant prognostic factor. Therefore, diligent search for "stromal microinvasion" with adequate sampling of tumor tissue are important at the time of histopathologic diagnosis, and patients with IECMI should no longer be treated identically to those with IEC.
本研究旨在评估肠型Ⅰ期卵巢黏液性囊腺癌（MAC）患者中肿瘤间质浸润程度的临床预后。
我们回顾性分析了 1994 年 1 月至 2009 年 7 月在 Asan 医疗中心治疗的 113 例Ⅰ期卵巢 MAC 患者的病历和病理切片。根据最近的组织病理学标准，MAC 分为 3 组：无浸润的上皮内癌（IEC）、微浸润的上皮内癌（IECMI）和广泛浸润的黏液性腺癌（MACEI）。肿瘤内仅见巨噬细胞组成的黏液性肉芽肿，无恶性细胞，无间质浸润。
在 113 例患者中，54 例（47.8%）为 IEC，15 例（13.3%）为 IECMI，44 例（38.9%）为 MACEI。3 组间患者年龄、绝经状态、CA-125 水平、手术方式、分期、囊膜和脉管间隙侵犯无差异。IEC、IECMI 和 MACEI 组的 5 年无病生存率分别为 97.7%、77.3%和 79.9%（IEC 与 IECMI，P=0.004；IEC 与 MACEI，P=0.012；IECMI 与 MACEI，P=0.555）。与 IEC 相比，IECMI 患者的预后较差，但与 MACEI 患者的预后无差异。
卵巢 MAC 的间质微浸润是一个重要的预后因素。因此，在组织病理学诊断时，应充分取材肿瘤组织，仔细寻找“间质微浸润”，IECMI 患者的治疗不应再与 IEC 患者相同。
