Richardson M T, Routson S, Karam A, Dorigo O, Levy K, Renz M, Diver E J
Stanford Women's Cancer Center, Stanford Cancer Institute, Division of Gynecologic Oncology, Stanford University School of Medicine, Stanford, CA, USA.
Gynecol Oncol Rep. 2020 Jun 3;33:100595. doi: 10.1016/j.gore.2020.100595. eCollection 2020 Aug.
To investigate the utility of asymptomatic screening, including CA-125, imaging, and pelvic exam, in the diagnosis and management of recurrent ovarian cancer.
Women with ovarian cancer whose cancer recurred after remission were categorized by first method that their provider suspected disease recurrence: CA-125, imaging, symptoms, or physical exam. Differences in clinicopathologic, primary treatment characteristics, and outcomes data including secondary cytoreductive surgery (SCS) outcome and overall survival (OS) were collected.
102 patients were identified at our institution from 2003 to 2015. 20 recurrences were detected by symptoms, while 62 recurrences were diagnosed first by asymptomatic rise in CA-125, 5 by pelvic exam, and 15 by imaging in the absence of known exam abnormality or rise in CA-125.Mean time to recurrence was 18.9 months, and median survival was 45.8 months. These did not vary by recurrence detection method (all p > 0.4). Patients whose disease was detected by CA-125 were less likely to undergo SCS than those detected by other means (21.7% vs. 35.0%, p = 0.007). In addition to the 5 patients whose recurrence was detected primarily by pelvic exam, an additional 10 (total n = 15) patients had an abnormal pelvic exam at time of diagnosis of recurrence.
Recurrence detection method was not associated with differing rates of survival or optimal SCS, however those patients detected by CA-125 were less likely to undergo SCS. The pelvic exam was a useful tool for detecting a significant proportion of recurrences.
探讨无症状筛查（包括CA-125检测、影像学检查和盆腔检查）在复发性卵巢癌诊断和管理中的作用。
将缓解后癌症复发的卵巢癌女性患者，按照其医疗服务提供者怀疑疾病复发的第一种方法进行分类：CA-125检测、影像学检查、症状或体格检查。收集临床病理、初始治疗特征以及包括二次细胞减灭术（SCS）结果和总生存期（OS）在内的结局数据。
2003年至2015年期间，在我们机构共确定了102例患者。20例复发通过症状检测到，62例复发首先通过CA-125无症状升高诊断，5例通过盆腔检查诊断，15例通过影像学检查诊断，此时无已知的检查异常或CA-125升高。复发的平均时间为18.9个月，中位生存期为45.8个月。这些指标在不同的复发检测方法之间没有差异（所有p>0.4）。通过CA-125检测到疾病的患者比通过其他方法检测到的患者接受SCS的可能性更小（21.7%对35.0%，p=0.007）。除了5例主要通过盆腔检查检测到复发的患者外，另有10例（共15例）患者在复发诊断时盆腔检查异常。
复发检测方法与不同的生存率或最佳SCS发生率无关，然而通过CA-125检测到的患者接受SCS的可能性更小。盆腔检查是检测相当一部分复发的有用工具。
