Rubin S C, Jones W B, Curtin J P, Barakat R R, Hakes T B, Hoskins W J
Department of Surgery, Memorial Sloan-Kettering Cancer Center, New York, New York.
Obstet Gynecol. 1993 Jul;82(1):139-42.
To evaluate the role of second-look laparotomy in patients with comprehensively staged stage I epithelial ovarian cancer.
We reviewed the medical records and obtained long-term follow-up on 54 stage I patients who had second-look laparotomies following complete surgical staging and chemotherapy.
The distribution by stage was as follows: stage IA 18 (33%), stage IB two (4%), and stage IC 34 (63%). Eighteen patients (33%) had endometrioid tumors, 12 (22%) clear cell, 13 (24%) mucinous, eight (15%) serous, and three (6%) undifferentiated. Forty-four patients (82%) had grade 2 or 3 tumors. Thirty-eight (70%) were treated with platinum-based regimens and 16 (30%) received non-platinum regimens. At second-look laparotomy, tumor was identified in three women (5.5%). Stage, cell type, and grade did not predict the second-look laparotomy result, although no patient with a grade 1 tumor had a positive second-look laparotomy. With a mean follow-up of 48 months from second-look laparotomy, 11 women (22%) have had recurrences following negative second looks. Tumor grade was a strong predictor of recurrence following negative second-look laparotomy (P < .0001), with the risk of recurrence being 0% for grades 1 and 2 and 52% for grade 3. Substage, cell type, and chemotherapy type and duration did not predict recurrence.
The likelihood of a positive second-look laparotomy is about 5% in well-staged stage I ovarian cancer. Patients with stage I, grade 3 tumors have a risk of recurrence of approximately 50% following negative second-look laparotomy.
评估二次剖腹探查术在全面分期的Ⅰ期上皮性卵巢癌患者中的作用。
我们回顾了54例在完成手术分期及化疗后接受二次剖腹探查术的Ⅰ期患者的病历，并进行了长期随访。
分期分布如下：ⅠA期18例（33%），ⅠB期2例（4%），ⅠC期34例（63%）。18例（33%）为子宫内膜样肿瘤，12例（22%）为透明细胞癌，13例（24%）为黏液性癌，8例（15%）为浆液性癌，3例（6%）为未分化癌。44例（82%）为2级或3级肿瘤。38例（70%）接受铂类方案治疗，16例（30%）接受非铂类方案治疗。二次剖腹探查术中，3名女性（5.5%）发现有肿瘤。分期、细胞类型和分级并不能预测二次剖腹探查术的结果，不过没有1级肿瘤患者的二次剖腹探查术结果呈阳性。二次剖腹探查术后平均随访48个月，11名女性（22%）在二次探查结果为阴性后出现复发。肿瘤分级是二次探查结果为阴性后复发的有力预测指标（P <.0001），1级和2级复发风险为0%，3级为52%。亚分期、细胞类型、化疗类型及疗程均不能预测复发。
在分期良好的Ⅰ期卵巢癌中，二次剖腹探查术结果为阳性的可能性约为5%。Ⅰ期3级肿瘤患者在二次探查结果为阴性后复发风险约为50%。
