Suzuki Kayo, Takakura Satoshi, Saito Motoaki, Morikawa Asuka, Suzuki Jiro, Takahashi Kazuaki, Nagata Chie, Yanaihara Nozomu, Tanabe Hiroshi, Okamoto Aikou
*Department of Obstetrics and Gynecology, The Jikei University Kashiwa Hospital, Kashiwa; and †Department of Obstetrics and Gynecology, The Jikei University School of Medicine; ‡Department of Obstetrics and Gynecology, The Jikei University Daisan Hospital; and §Department of Obstetrics and Gynecology, The Jikei University Katsushika Medical Center, Tokyo, Japan.
Int J Gynecol Cancer. 2014 Sep;24(7):1181-9. doi: 10.1097/IGC.0000000000000178.
The aim of this study was to evaluate the impact of surgical staging in stage I clear cell adenocarcinoma of the ovary (CCC).
We performed a retrospective review of 165 patients with stage I CCC treated with optimal or nonoptimal staging surgery.
The median follow-up period in this study was 67 months. No significant difference was detected in recurrence-free survival (RFS) or overall survival (OS) between patients optimally and nonoptimally staged (RFS: P = 0.434; OS: P = 0.759). The estimated 5-year RFS and OS rates were 92.1% and 95.3% in patients with stages IA/IC1 and 81.0% and 83.7% in stages IC2/IC3, respectively. The multivariate analysis indicated that stages IC2/IC3 predicted worse RFS and OS than stages IA/IC1 in stage I CCC patients (RFS: P = 0.011; OS: P = 0.011). Subsequently, we investigated the impact of surgical staging, respectively, in stages IA/IC1 and stages IC2/IC3. Significant differences were observed in PFS and OS between patients optimally and nonoptimally staged with stages IA/IC1 (RFS: P = 0.021; OS: P = 0.024), but no significant difference was found in those with stages IC2/IC3. The multivariate analysis indicated that nonoptimal staging surgery predicted worse RFS than the optimal staging surgery in stages IA/IC1 CCC patients (P = 0.033). In addition, we investigated the impact of surgical staging for stages IA/IC1 in the adjuvant chemotherapy group. The 5-year RFS and OS rates in patients optimally and nonoptimally staged with stages IA/IC1 in the adjuvant chemotherapy group were 97.8% and 100%, and 85.2% and 89.4%, respectively. The multivariate analysis indicated that nonoptimal staging surgery predicted worse RFS than the optimal staging surgery for stages IA/IC1 patients in the adjuvant chemotherapy group (P = 0.019).
The prognosis for women with stage 1A/IC1 is very good. Surgical staging category was the only independent prognostic factor for RFS in stages IA/IC1 CCC.
本研究旨在评估手术分期对Ⅰ期卵巢透明细胞腺癌（CCC）的影响。
我们对165例行最佳或非最佳分期手术的Ⅰ期CCC患者进行了回顾性研究。
本研究的中位随访期为67个月。最佳分期和非最佳分期患者的无复发生存期（RFS）或总生存期（OS）无显著差异（RFS：P = 0.434；OS：P = 0.759）。ⅠA/ⅠC1期患者的估计5年RFS率和OS率分别为92.1%和95.3%，ⅠC2/ⅠC3期分别为81.0%和83.7%。多因素分析表明，Ⅰ期CCC患者中，ⅠC2/ⅠC3期的RFS和OS比ⅠA/ⅠC1期差（RFS：P = 0.011；OS：P = 0.011）。随后，我们分别研究了手术分期在ⅠA/ⅠC1期和ⅠC2/ⅠC3期的影响。ⅠA/ⅠC1期最佳分期和非最佳分期患者的PFS和OS存在显著差异（RFS：P = 0.021；OS：P = 0.024），但ⅠC2/ⅠC3期患者无显著差异。多因素分析表明，ⅠA/ⅠC1期CCC患者中，非最佳分期手术的RFS比最佳分期手术差（P = 0.033）。此外，我们研究了辅助化疗组中ⅠA/ⅠC1期手术分期的影响。辅助化疗组中ⅠA/ⅠC1期最佳分期和非最佳分期患者的5年RFS率和OS率分别为97.8%和100%，85.2%和89.4%。多因素分析表明，辅助化疗组中ⅠA/ⅠC1期患者非最佳分期手术的RFS比最佳分期手术差（P = 0.019）。
ⅠA/ⅠC1期女性的预后非常好。手术分期类别是ⅠA/ⅠC1期CCC患者RFS的唯一独立预后因素。
