Young R C
Medicine Branch, National Cancer Institute, Bethesda, Maryland 20892.
Cancer. 1987 Oct 15;60(8 Suppl):2042-9. doi: 10.1002/1097-0142(19901015)60:8+<2042::aid-cncr2820601516>3.0.co;2-d.
Approximately 33% of women with invasive ovarian tumors present with what appears to be early epithelial ovarian cancer (FIGO Stages I and II) accounting for approximately 6000 new ovarian cancer cases each year in the United States. A better understanding of the natural history and patterns of spread of this disease has led to an increased awareness of the importance of thorough operative staging, cytoreductive surgery, and accurate determination of the extent of residual disease. These staging studies have documented frequent understaging of such patients. Results from such surgical staging studies indicate that only about 25% of women operated on in the United States have an initial surgical incision adequate to allow evaluation of the entire pelvis and abdominal cavity. As a result about 33% of patients thought to be free of disease at initial surgery have residual disease and in 75% the disease has spread intraabdominally. These studies have important implications for the design of future adjuvant trials. Fortunately, these accurate staging studies have defined groups of patients who require adjuvant treatment as well as those who do not. It is now apparent that certain groups of patients with Stage II and high-risk Stage I disease are at risk for failure throughout the abdominal cavity. Any form of adjuvant therapy, if it is to succeed, must obviously encompass this entire area. With this in mind, several prospective clinical trials have tested a variety of adjuvant approaches. Present evidence would suggest that systemic chemotherapy, intraperitoneal radioisotopes (32P) or whole abdominal irradiation have the potential to eradicate micrometastases throughout the area at risk. The need for adjuvant therapy is dependent upon the accuracy of initial surgical staging. If initial surgical evaluation was incomplete, the five year survival rates for Stage I (70%) and Stage II (40% to 50%) disease are poor enough that most investigators would advocate some sort of adjuvant therapy. However, comprehensive and accurate surgical staging will define subsets of ovarian cancer patients with such good prognoses (five year survival of 90% to 95%) that no adjuvant treatment is required. With the known risk of late second malignancies in ovarian cancer patients treated with long-term adjuvant chemotherapy, the identification of patients who do not require further treatment represents an advance. Accurate surgical staging coupled with proper adjuvant therapy designed to treat areas of high risk have improved the survival rate of patients with early ovarian cancer.
患有侵袭性卵巢肿瘤的女性中，约33%表现为看似早期的上皮性卵巢癌（国际妇产科联盟（FIGO）分期I期和II期），在美国每年约有6000例新发卵巢癌病例属于这种情况。对这种疾病自然史和扩散模式的更好理解，使得人们更加意识到全面手术分期、肿瘤细胞减灭术以及准确确定残留病灶范围的重要性。这些分期研究表明，这类患者常常存在分期不足的情况。此类手术分期研究结果显示，在美国接受手术的女性中，只有约25%的患者最初的手术切口足以对整个盆腔和腹腔进行评估。因此，约33%在初次手术时被认为无疾病的患者存在残留病灶，且75%的患者疾病已在腹腔内扩散。这些研究对未来辅助治疗试验的设计具有重要意义。幸运的是，这些准确的分期研究明确了需要辅助治疗的患者群体以及不需要辅助治疗的患者群体。现在很明显，某些II期和高危I期疾病患者存在整个腹腔内复发的风险。如果任何形式的辅助治疗要取得成功，显然必须覆盖整个这一区域。考虑到这一点，几项前瞻性临床试验对多种辅助治疗方法进行了测试。目前的证据表明，全身化疗、腹腔内放射性同位素（32P）或全腹照射有可能根除整个有风险区域的微小转移灶。辅助治疗的必要性取决于初次手术分期的准确性。如果初次手术评估不完整，I期（70%）和II期（40%至50%）疾病的五年生存率很低，以至于大多数研究者会主张某种形式的辅助治疗。然而，全面而准确的手术分期将确定一部分预后良好（五年生存率为90%至95%）的卵巢癌患者亚组，这些患者不需要辅助治疗。鉴于接受长期辅助化疗的卵巢癌患者存在晚期第二原发恶性肿瘤的已知风险，识别出不需要进一步治疗的患者代表了一种进步。准确的手术分期加上旨在治疗高危区域的适当辅助治疗，提高了早期卵巢癌患者的生存率。
