Wang Tiantian, Zeng Jia, Li Ning, Zhang Rong, Song Yan, Wu Lingying
Department of Gynecologic Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College Beijing 100021, China.
Am J Cancer Res. 2020 Dec 1;10(12):4561-4567. eCollection 2020.
This retrospective cohort study was designed to explore the prognostic impact of adjuvant chemotherapy and tumor substage on stage I ovarian clear cell carcinoma (OCCC). Data of 102 patients with stage I OCCC who underwent surgery at the National Cancer Center/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College from February 1999 to December 2018 was retrospectively analyzed. Prognostic factors were evaluated using the Cox Regression Model. The disease-free survival (DFS) and overall survival (OS) were assessed by the Kaplan-Meier method and compared between different groups with the log-rank test. P < 0.05 was considered statistically significant. The median follow-up duration was 40.5 months. Thirty-one (30.4%) patients were at stage IA, and 17 (16.7%), 5 (24.5%) and 17 (16.7%) patients were at stage IC1, IC2 and IC3 respectively. The 5-year and 10-year DFS rates of the entire cohort were 82.8% and 78.8% respectively, and the 5-year OS was 97.9%. Patients at stages ICI (intraoperatively ruptured tumor) and IA had similar DFS (P=0.538, OR=0.024), and that of patients at stages IC2 (tumor ruptured preoperatively or tumor on ovarian surface) or IC3 (ascites or peritoneal washings with positive cytology) was significantly lower (72.6% vs. 95.1%, P=0.039, OR=5.051). The 5-year DFS of patients receiving four (83.9%) and more than four (81.7%) cycles adjuvant chemotherapy were similar. Furthermore, univariate analysis showed that age, tumor size and CA199 levels were significantly correlated with DFS, although none of these variables were identified as independent prognostic factors in the multivariate analysis. In summary, our results suggest that patients with stage I OCCC have overall good prognosis. However, tumor surface involvement or positive cytology can worsen prognosis, and the prognosis may not be improved by more than four cycles chemotherapy following surgery. The remarkable increased CA199 may be a potential indicator of poor prognosis in stage I OCCC.
本回顾性队列研究旨在探讨辅助化疗和肿瘤亚分期对Ⅰ期卵巢透明细胞癌（OCCC）预后的影响。对1999年2月至2018年12月在中国医学科学院肿瘤医院/国家癌症中心接受手术的102例Ⅰ期OCCC患者的数据进行回顾性分析。采用Cox回归模型评估预后因素。采用Kaplan-Meier法评估无病生存期（DFS）和总生存期（OS），并通过对数秩检验比较不同组之间的差异。P<0.05被认为具有统计学意义。中位随访时间为40.5个月。31例（30.4%）患者为ⅠA期，17例（16.7%）、5例（24.5%）和17例（16.7%）患者分别为ⅠC1、ⅠC2和ⅠC3期。整个队列的5年和10年DFS率分别为82.8%和78.8%，5年OS为97.9%。ⅠC1期（术中肿瘤破裂）和ⅠA期患者的DFS相似（P=0.538，OR=0.024），而ⅠC2期（术前肿瘤破裂或肿瘤位于卵巢表面）或ⅠC3期（腹水或腹腔冲洗液细胞学阳性）患者的DFS显著较低（72.6%对95.1%，P=0.039，OR=5.051）。接受四个（83.9%）及以上四个（81.7%）周期辅助化疗的患者的5年DFS相似。此外，单因素分析显示年龄、肿瘤大小和CA199水平与DFS显著相关，尽管在多因素分析中这些变量均未被确定为独立预后因素。总之，我们的结果表明，Ⅰ期OCCC患者总体预后良好。然而，肿瘤表面受累或细胞学阳性会使预后恶化，术后超过四个周期的化疗可能无法改善预后。CA199显著升高可能是Ⅰ期OCCC预后不良的潜在指标。
