Gershenson D M, Silva E G
Department of Gynecology, University of Texas M. D. Anderson Cancer Center, Houston 77030.
Cancer. 1990 Feb 1;65(3):578-85. doi: 10.1002/1097-0142(19900201)65:3<578::aid-cncr2820650332>3.0.co;2-n.
Between 1956 and 1985, 82 patients with metastatic low-grade serous ovarian carcinoma, subsequently reclassified by pathologic review as serous ovarian tumors of low malignant potential with peritoneal implants, were seen at the authors' institution. Median age was 34 years (range, 17-64 years). Original stage distribution was as follows: 32 Stage II, 46 Stage III, and four Stage IV. Peritoneal implants in 72 patients were classified as benign (22 patients), noninvasive (37), or invasive (13). For ten patients, implants were clinically documented but histologic material was unavailable. The most common sites of peritoneal implants included the pelvic peritoneum (42), omentum (33), uterus (33), and fallopian tube (26). All patients underwent primary surgery. Postoperative therapy consisted of radiotherapy in 18 patients, single-agent chemotherapy in 37 patients, combination chemotherapy in 25 patients, and no therapy in two patients. Second-look laparotomy documented response to chemotherapy in 42% of patients with no gross residual disease and in 80% of patients with macroscopic residual disease (40% complete response, 40% partial response). Disease-free survival rates were 95% at 5 years and 91% at 10 years. The International Federation of Gynecologists and Obstetricians (FIGO) stage, extent of residual disease, type of postoperative treatment, and type of peritoneal implants had no effect on survival. Based on a comparison of the present study's findings with those in the literature, the authors propose possible explanations for differences in survival by type of peritoneal implants and outline recommendations for clinical management until further studies elucidate the role of postoperative therapy.
1956年至1985年间，作者所在机构收治了82例转移性低级别浆液性卵巢癌患者，经病理复查后重新分类为伴有腹膜种植的低恶性潜能浆液性卵巢肿瘤。中位年龄为34岁（范围17 - 64岁）。初始分期分布如下：32例为II期，46例为III期，4例为IV期。72例患者的腹膜种植被分类为良性（22例）、非侵袭性（37例）或侵袭性（13例）。10例患者有临床记录的种植，但无法获得组织学材料。腹膜种植最常见的部位包括盆腔腹膜（42例）、大网膜（33例）、子宫（33例）和输卵管（26例）。所有患者均接受了初次手术。术后治疗包括18例患者接受放疗，37例患者接受单药化疗，25例患者接受联合化疗，2例患者未接受治疗。二次剖腹探查显示，无肉眼残留疾病的患者中42%对化疗有反应，有肉眼残留疾病的患者中80%有反应（40%完全缓解，40%部分缓解）。5年无病生存率为95%，10年为91%。国际妇产科联合会（FIGO）分期、残留疾病范围、术后治疗类型和腹膜种植类型对生存率均无影响。基于本研究结果与文献的比较，作者提出了腹膜种植类型导致生存率差异的可能解释，并概述了临床管理建议，直至进一步研究阐明术后治疗的作用。
