Gershenson D M, Silva E G, Levy L, Burke T W, Wolf J K, Tornos C
Department of Gynecologic Oncology, The University of Texas M. D. Anderson Cancer Center, Houston 77030, USA.
Cancer. 1998 Mar 15;82(6):1096-103.
The objective of the current study was to update the authors' experience with patients with ovarian serous borderline tumors with invasive peritoneal implants to gain additional insight into the biologic behavior of these tumors and a better understanding of the effect of postoperative treatment.
Thirty-nine patients with ovarian serous borderline tumors with invasive peritoneal implants were identified through a retrospective review. Major endpoints selected for analysis were surgicopathologic response, time to recurrence, type of recurrence, progression free survival, and overall survival. Univariate and multivariate regression analyses also were performed.
Median follow-up time was 111 months. Four of 7 evaluable patients who had second-look surgery (57%) had a response to chemotherapy. Twelve of 39 patients (31%) either developed progressive disease or had a recurrence. The median time from date of diagnosis to recurrence was 24 months. In 10 of these 12 patients with a recurrence, tissue was available; 9 had invasive low grade serous carcinoma and 1 had a recurrent borderline tumor. Macroscopic residual disease was the only factor studied that had a significant effect on survival; patients with no macroscopic residual tumor had a significantly better survival than those with any macroscopic residual tumor (P < 0.01). In univariate regression analysis, macroscopic residual disease and the presence of frankly invasive implants were significant predictors of progression free survival. Platinum-based chemotherapy was associated with a significantly shorter progression-free survival. Only macroscopic residual tumor was a significant predictor of survival.
Greater than 30% of patients with ovarian serous borderline tumors with invasive peritoneal implants will develop progressive or recurrent tumor, most commonly serous carcinoma. The presence of macroscopic residual disease appears to be the major predictor of recurrence and survival. However, in this study, the authors were unable to elucidate the role of postoperative therapy or the criteria for selection of patients for such therapy.
本研究的目的是更新作者对伴有浸润性腹膜种植的卵巢浆液性交界性肿瘤患者的治疗经验，以进一步了解这些肿瘤的生物学行为，并更好地理解术后治疗的效果。
通过回顾性研究确定了39例伴有浸润性腹膜种植的卵巢浆液性交界性肿瘤患者。选择进行分析的主要终点包括手术病理反应、复发时间、复发类型、无进展生存期和总生存期。还进行了单因素和多因素回归分析。
中位随访时间为111个月。7例接受二次探查手术的可评估患者中有4例（57%）对化疗有反应。39例患者中有12例（31%）出现疾病进展或复发。从诊断到复发的中位时间为24个月。在这12例复发患者中的10例中，有可用组织；9例为浸润性低级别浆液性癌，1例为复发性交界性肿瘤。肉眼可见残留病灶是所研究的唯一对生存有显著影响的因素；无肉眼可见残留肿瘤的患者的生存期明显优于有任何肉眼可见残留肿瘤的患者（P<0.01）。在单因素回归分析中，肉眼可见残留病灶和存在明显浸润性种植是无进展生存期的显著预测因素。铂类化疗与明显缩短的无进展生存期相关。只有肉眼可见残留肿瘤是生存的显著预测因素。
超过30%的伴有浸润性腹膜种植的卵巢浆液性交界性肿瘤患者会出现肿瘤进展或复发，最常见的是浆液性癌。肉眼可见残留病灶的存在似乎是复发和生存的主要预测因素。然而，在本研究中，作者未能阐明术后治疗的作用或选择此类治疗患者的标准。
