Sainz de la Cuesta R, Goff B A, Fuller A F, Nikrui N, Eichhorn J H, Rice L W
Vincent Memorial Gynecologic Oncology Service, Massachusetts General Hospital, Harvard Medical School, Boston.
Obstet Gynecol. 1994 Jul;84(1):1-7.
To determine whether rupture of malignant ovarian epithelial tumors at the time of operation influences the patient's overall prognosis.
Between 1975 and 1990, 79 patients with stage I invasive epithelial ovarian cancer were treated at Massachusetts General Hospital. Patients were identified from the tumor registry, and charts were reviewed retrospectively. In 71 of the 79 cases, pathologic slides were evaluated. Of the 79 patients, 36 had stage Ia tumors, 20 stage Ic secondary to intraoperative rupture (Ic-rupture), and 17 stage Ic secondary to capsular invasion-serosal disease or positive ascites or washings (stage Ic-other). Survival analysis was performed to compare the three groups of patients.
There were four recurrences and deaths among the 20 women with stage Ic-rupture tumors (20%), compared to one (3%) among the 36 women with stage Ia. The recurrence-free survival at the median follow-up time for the two groups was 97 +/- 3 and 78 +/- 10 months, respectively (P = .03); overall survival was 97 +/- 3 and 73 +/- 12 months (P = .04). There were two recurrences (12%) and one death (6%) among the 17 women with stage Ic-other, giving recurrence-free and overall survivals of 88 +/- 8 and 94 +/- 6 months, respectively. The survival experience of this last group was not significantly different from that in the Ic-rupture group (P = .2). The hazard ratios for overall survival associated with stage Ic-rupture and each potential confounder, except for bloating, exceeded 6.5, with P < or = .10. All deaths occurred in the 28 patients with grade 2 or 3 tumors. Even in this smaller group, the hazard ratio for stage Ic-rupture was 6.8 (P = .09).
Intraoperative rupture of malignant epithelial ovarian neoplasms may worsen the prognosis of patients with stage I ovarian cancer.
确定手术时恶性卵巢上皮性肿瘤破裂是否会影响患者的总体预后。
1975年至1990年间，马萨诸塞州总医院治疗了79例I期侵袭性上皮性卵巢癌患者。从肿瘤登记处识别出患者，并对病历进行回顾性审查。79例病例中的71例评估了病理切片。79例患者中，36例为Ia期肿瘤，20例为术中破裂继发的Ic期（Ic-破裂），17例为包膜侵犯-浆膜疾病或腹水或冲洗液阳性继发的Ic期（Ic-其他）。进行生存分析以比较三组患者。
20例Ic-破裂期肿瘤女性中有4例复发和死亡（20%），相比之下，36例Ia期女性中有1例（3%）。两组中位随访时间的无复发生存率分别为97±3个月和78±10个月（P = 0.03）；总生存率分别为97±3个月和73±12个月（P = 0.04）。17例Ic-其他期女性中有2例复发（12%）和1例死亡（6%），无复发生存率和总生存率分别为88±8个月和94±6个月。最后一组的生存情况与Ic-破裂组无显著差异（P = 0.2）。除腹胀外，与Ic-破裂及各潜在混杂因素相关的总生存风险比均超过6.5，P≤0.10。所有死亡均发生在28例2级或3级肿瘤患者中。即使在这个较小的组中，Ic-破裂的风险比为6.8（P = 0.09）。
恶性上皮性卵巢肿瘤术中破裂可能会使I期卵巢癌患者的预后恶化。
