Department of Obstetrics and Gynaecology, St Elisabeth Hospital, Tilburg, The Netherlands.
Int J Gynecol Cancer. 2012 Oct;22(8):1325-31. doi: 10.1097/IGC.0b013e3182679119.
For treatment of patients with both endometrial and ovarian cancer, it is important to discriminate between 2 primary tumors and metastatic disease. Currently, criteria are based on postoperative findings. The aim of this study was to determine whether clinical parameters can discriminate between these groups preoperatively and whether a practical guideline could improve appropriate workup and treatment.
A total of 45 patients with a diagnosis of both endometrium and ovarian cancer between 1998 and 2009 and were included for analysis. Clinical and pathological data were obtained, and initial CA-125 was registered; patients had a diagnosis of 2 primary tumors or tumors with metastasis. All patients were reclassified according to workup and treatment.
Patients with synchronous primary tumors were significantly younger, presented more often with abnormal uterine bleeding, and had a lower initial CA-125 than both metastatic groups (P < 0.05). With age and CA-125 included in a polytomic logistic regression model, 83.3% of diagnoses could be classified correctly. In 15 of 17 patients presented with adnexal mass, workup was incomplete owing to lack on information of the endometrial status. In patients presenting with abnormal uterine bleeding, 13 of 21 patients had an incomplete workup leading to staging laparotomy secondary to initial surgical treatment in 2 patients.
Patients with synchronous endometrial and ovarian cancers are young, often present with abnormal uterine bleeding and have a low initial CA-125. Adequate workup with attention to both ovarian and endometrial status, especially in young patients with a wish to preserve fertility, is important to make the right decision for treatment.
对于同时患有子宫内膜癌和卵巢癌的患者，区分两种原发性肿瘤和转移性疾病非常重要。目前，标准基于术后发现。本研究旨在确定临床参数是否可以在术前区分这些组，以及是否可以制定实用的指南来改善适当的检查和治疗。
本研究共纳入了 1998 年至 2009 年间诊断为子宫内膜和卵巢癌的 45 例患者进行分析。收集了临床和病理数据，并记录了初始 CA-125；患者被诊断为两种原发性肿瘤或有转移的肿瘤。所有患者均根据检查和治疗进行重新分类。
同步原发性肿瘤患者明显更年轻，常出现异常子宫出血，且初始 CA-125 低于两种转移组（P<0.05）。在包含年龄和 CA-125 的多元逻辑回归模型中，83.3%的诊断可以正确分类。在 17 例表现为附件包块的患者中，由于缺乏子宫内膜状态的信息，检查并不完整。在表现为异常子宫出血的 21 例患者中，有 13 例检查不完整，导致 2 例患者因初始手术治疗而进行分期腹腔镜检查。
患有同步子宫内膜癌和卵巢癌的患者年轻，常出现异常子宫出血，且初始 CA-125 较低。充分的检查，注意卵巢和子宫内膜的状态，尤其是在有生育愿望的年轻患者中，对于做出正确的治疗决策非常重要。
