Kimball R E, Schlaerth J B, Kute T E, Schlaerth A C, Santoso J, Ballon S C, Spirtos N M
Women's Cancer Center of Northern California, Palo Alto 94304, USA.
Am J Obstet Gynecol. 1997 Jun;176(6):1319-26; discussion 1326-7. doi: 10.1016/s0002-9378(97)70352-1.
This study was undertaken to evaluate the deoxyribonucleic acid content and S-phase fraction in advanced epithelial ovarian carcinomas to determine whether lymph node metastases are biologically distinct from peritoneal sites of metastases.
Thirty-five patients with stage III or IV epithelial ovarian cancer who had undergone complete pelvic and paraaortic lymphadenectomy had representative samples from the primary ovarian tumor, peritoneal metastases, and lymph node metastases analyzed by flow cytometry for deoxyribonucleic acid nuclear content and S-phase fraction.
Diploid cell lines are found in metastatic lymph nodes (52%) significantly more frequently than in peritoneal metastases (25%, p < 0.02) or in primary ovarian tumors (26%, p < 0.001). The ploidy category frequency distribution of peritoneal metastases mirrors that found in the primary tumor, and both are significantly different from the ploidy category frequency distribution found in metastatic lymph nodes. Heterogeneity among sites is common, being identified in 54% of patients. Peritoneal metastases are more likely to be concordant with the primary tumor (69%) than are lymph node metastases (39%, p < 0.001). Mean S-phase fraction did not differ overall by site but was significantly different between diploid and aneuploid samples by site. Diploid lymph node metastases were found to have the lowest mean S-phase fraction (7.2% +/- 3.3%), and aneuploid lymph node metastases had the highest mean S-phase fraction (22.3% +/- 10.2%). Diploidy of the primary tumor is a positive predictor of long-term survival. Tumoral heterogeneity and lymph node metastases are not related to survival in this group of patients who underwent therapeutic pelvic and aortic lymphadenectomy.
A high proportion of tumor deposits found in metastatic lymph nodes are diploid with a low S-phase fraction. Therapeutic pelvic and aortic lymph node dissection removes disease that, on the basis of flow cytometric characteristics, may be predicted to be resistant to chemotherapy and radiation therapy.
本研究旨在评估晚期上皮性卵巢癌的脱氧核糖核酸含量和S期细胞比例，以确定淋巴结转移在生物学上是否与腹膜转移部位不同。
35例接受了完全盆腔和腹主动脉旁淋巴结清扫术的III期或IV期上皮性卵巢癌患者，其原发性卵巢肿瘤、腹膜转移灶和淋巴结转移灶的代表性样本通过流式细胞术分析脱氧核糖核酸核含量和S期细胞比例。
在转移性淋巴结中发现二倍体细胞系的频率（52%）显著高于腹膜转移灶（25%，p<0.02）或原发性卵巢肿瘤（26%，p<0.001）。腹膜转移灶的倍体类别频率分布与原发性肿瘤相似，且两者均与转移性淋巴结中的倍体类别频率分布显著不同。各部位之间的异质性很常见，在54%的患者中被发现。腹膜转移灶比淋巴结转移灶更可能与原发性肿瘤一致（69%对39%，p<0.001）。平均S期细胞比例总体上不因部位而异，但按部位在二倍体和非整倍体样本之间有显著差异。发现二倍体淋巴结转移灶的平均S期细胞比例最低（7.2%±3.3%），非整倍体淋巴结转移灶的平均S期细胞比例最高（22.3%±10.2%）。原发性肿瘤的二倍体是长期生存的阳性预测指标。在接受治疗性盆腔和主动脉淋巴结清扫术的这组患者中，肿瘤异质性和淋巴结转移与生存无关。
在转移性淋巴结中发现的高比例肿瘤沉积物为二倍体，S期细胞比例低。治疗性盆腔和主动脉淋巴结清扫术清除的疾病，根据流式细胞术特征，可能预计对化疗和放疗耐药。
