Moss Esther Louise, Evans Tim, Pearmain Philippa, Askew Sarah, Singh Kavita, Chan Kiong K, Ganesan Raji, Hirschowitz Lynn
*Leicester General Hospital, University Hospital of Leicester, Leicester, UK; †West Midlands Cancer Intelligence Unit (now known as Knowledge and Intelligence Team [West Midlands], Public Health, England), Birmingham, UK; ‡Pan Birmingham Gynaecological Cancer Centre, Birmingham, UK.
Int J Gynecol Cancer. 2015 Sep;25(7):1201-7. doi: 10.1097/IGC.0000000000000477.
The dualistic theory of ovarian carcinogenesis proposes that epithelial "ovarian" cancer is not one entity with several histological subtypes but a collection of different diseases arising from cells of different origin, some of which may not originate in the ovarian surface epithelium.
All cases referred to the Pan-Birmingham Gynaecological Cancer Centre with an ovarian, tubal, or primary peritoneal cancer between April 2006 and April 2012 were identified from the West Midlands Cancer Registry. Tumors were classified into type I (low-grade endometrioid, clear cell, mucinous, and low-grade serous) and type II (high-grade serous, high-grade endometrioid, carcinosarcoma, and undifferentiated) cancers.
Ovarian (83.5%), tubal (4.3%), or primary peritoneal carcinoma (12.2%) were diagnosed in a total of 583 woman. The ovarian tumors were type I in 134 cases (27.5%), type II in 325 cases (66.7%), and contained elements of both type I and type II tumors in 28 cases (5.7%). Most tubal and primary peritoneal cases, however, were type II tumors: 24 (96.0%) and 64 (90.1%), respectively. Only 16 (5.8%) of the ovarian high-grade serous carcinomas were stage I at diagnosis, whereas 240 (86.6%) were stage III+. Overall survival varied between the subtypes when matched for stage. Stage III low-grade serous and high-grade serous carcinomas had a significantly better survival compared to clear cell and mucinous cases, P = 0.0134. There was no significant difference in overall survival between the high-grade serous ovarian, tubal, or peritoneal carcinomas when matched for stage (stage III, P = 0.3758; stage IV, P = 0.4820).
Type II tumors are more common than type I and account for most tubal and peritoneal cancers. High-grade serous carcinomas, whether classified as ovarian/tubal/peritoneal, seem to behave as one disease entity with no significant difference in survival outcomes, therefore supporting the proposition of a separate classification of "tubo-ovarian serous carcinoma".
卵巢癌发生的二元论认为，上皮性“卵巢”癌并非具有几种组织学亚型的单一实体，而是由不同起源细胞产生的多种不同疾病的集合，其中一些可能并非起源于卵巢表面上皮。
从西米德兰兹癌症登记处识别出2006年4月至2012年4月间转诊至泛伯明翰妇科癌症中心的所有卵巢、输卵管或原发性腹膜癌病例。肿瘤被分为I型（低级别子宫内膜样癌、透明细胞癌、黏液性癌和低级别浆液性癌）和II型（高级别浆液性癌、高级别子宫内膜样癌、癌肉瘤和未分化癌）癌症。
共诊断出583例女性患有卵巢癌（83.5%）、输卵管癌（4.3%）或原发性腹膜癌（12.2%）。卵巢肿瘤中，I型134例（27.5%），II型325例（66.7%），I型和II型肿瘤成分均有的28例（5.7%）。然而，大多数输卵管和原发性腹膜癌病例为II型肿瘤：分别为24例（96.0%）和64例（90.1%）。卵巢高级别浆液性癌诊断时仅16例（5.8%）为I期，而240例（86.6%）为III期及以上。各亚型在分期匹配时总生存率有所不同。III期低级别浆液性癌和高级别浆液性癌的生存率明显优于透明细胞癌和黏液性癌病例，P = 0.0134。高级别浆液性卵巢癌、输卵管癌或腹膜癌在分期匹配时（III期，P = 0.3758；IV期，P = 0.4820）总生存率无显著差异。
II型肿瘤比I型更常见，且占大多数输卵管和腹膜癌。高级别浆液性癌，无论归类为卵巢/输卵管/腹膜癌，似乎表现为一种疾病实体，生存结果无显著差异，因此支持将“输卵管 - 卵巢浆液性癌”单独分类的提议。
