Sood A K, Sorosky J I, Gelder M S, Buller R E, Anderson B, Wilkinson E J, Benda J A, Morgan L S
Department of Obstetrics and Gynecology, University of Iowa Hospitals and Clinics, Iowa City 52242, USA.
Cancer. 1998 May 1;82(9):1731-7.
Data regarding the value of cytoreduction and cell histology in ovarian sarcomas are limited. The goal of this study was to assess the value of surgical cytoreduction, preoperative CA 125 levels, stage, histology, and platinum-based chemotherapy in the primary treatment of ovarian sarcomas.
A retrospective analysis of 47 women with primary ovarian sarcomas was performed.
Forty-one patients (87%) presented with advanced stage disease (International Federation of Gynecology and Obstetrics Stage III or IV). Optimal surgical cytoreduction (< 1 cm residual tumor burden) was achieved in 25 patients (53%). Forty patients (85%) had a malignant mixed müllerian tumor whereas 7 patients had a pure sarcoma. Eighteen women with mixed müllerian tumors had homologous tumors and 22 had heterologous elements. Patients treated with platinum-based chemotherapy were significantly more likely to have a response (P = 0.008) compared with those treated with other regimens. Treatment with platinum-based chemotherapy also showed a survival advantage (P = 0.03). Preoperative CA 125 levels were elevated (> 35 U/mL) in 93% of patients with ovarian sarcomas. A preoperative CA 125 level < 75 U/mL was significantly associated with better survival (P = 0.01). In univariate analysis, other significant predictors of improved survival were early stage (P = 0.04), homologous tumors (P < 0.05), and optimal surgical cytoreduction (P < 0.001). In multivariate analysis of various prognostic variables, optimal surgical cytoreduction (P < 0.001) was the most significant factor, followed by histologic subtype (P < 0.02).
Ovarian sarcomas are rare malignancies with a poor prognosis. All women with suspected ovarian carcinoma or sarcoma should have a preoperative CA 125 level taken. Surgical cytoreduction to a residual tumor burden of < or = 1 cm improves outcome and should be the goal of surgery. Although the optimal consolidation chemotherapy regimen remains unknown, platinum should be included as part of the regimen.
关于卵巢肉瘤中肿瘤细胞减灭术及细胞组织学价值的数据有限。本研究的目的是评估手术细胞减灭术、术前CA 125水平、分期、组织学类型以及铂类化疗在卵巢肉瘤初始治疗中的价值。
对47例原发性卵巢肉瘤患者进行回顾性分析。
41例患者（87%）表现为晚期疾病（国际妇产科联盟III期或IV期）。25例患者（53%）实现了最佳手术细胞减灭（残留肿瘤负荷<1 cm）。40例患者（85%）患有恶性混合性苗勒管肿瘤，7例患者患有纯肉瘤。18例患有混合性苗勒管肿瘤的患者为同源性肿瘤，22例含有异源性成分。与接受其他方案治疗的患者相比，接受铂类化疗的患者更有可能出现反应（P = 0.008）。铂类化疗治疗也显示出生存优势（P = 0.03）。93%的卵巢肉瘤患者术前CA 125水平升高（>35 U/mL）。术前CA 125水平<75 U/mL与更好的生存率显著相关（P = 0.01）。在单因素分析中，生存改善的其他显著预测因素为早期（P = 0.04）、同源性肿瘤（P < 0.05）以及最佳手术细胞减灭（P < 0.001）。在对各种预后变量的多因素分析中，最佳手术细胞减灭（P < 0.001）是最显著的因素，其次是组织学亚型（P < 0.02）。
卵巢肉瘤是预后较差的罕见恶性肿瘤。所有疑似卵巢癌或肉瘤的女性患者均应检测术前CA 125水平。将残留肿瘤负荷手术细胞减灭至≤1 cm可改善预后，应作为手术目标。尽管最佳巩固化疗方案尚不清楚，但铂类应作为方案的一部分。
