Zanetta G, Rota S, Chiari S, Bonazzi C, Bratina G, Torri V, Mangioni C
Department of Obstetrics and Gynecology, San Gerardo Hospital Monza, University of Milan, Italy.
Ann Oncol. 1998 Oct;9(10):1097-101. doi: 10.1023/a:1008424527668.
Several prognostic factors for stage I ovarian carcinoma have been analyzed. Some of them are biological and clinical in nature, but others such as the thoroughness of the staging procedure, the extent of the surgery and the philosophy of treatment, are defined by the human element.
We reviewed the records of 351 patients with Stage I ovarian cancer who had been treated from 1981 to 1991. For all patients the following information was available: age, size of the tumor, FIGO sub-stage, tumor grade, histologic type, rupture of the tumor, cytology, extent of the staging and of the surgery (hysterectomy and bilateral salpingo-oophorectomy vs. fertility-conserving surgery) and use of adjuvant treatments. The thoroughness of the staging was defined as: optimal staging: total abdominal hysterectomy and bilateral salpingo-oophorectomy or fertility-conserving surgery, peritoneal cytology or washing, omentectomy, multiple peritoneal biopsies, sampling of the retroperitoneal nodes or formal lymphadenectomy, peritoneal staging: all the criteria described above were met with the exception of retroperitoneal sampling, incomplete staging: lack of any of the previously-cited criteria.
An optimal staging was performed in 100 patients, a peritoneal staging in 107 and an incomplete staging in 144. Radical surgery was performed in 295 women and fertility-conserving surgery in 56. With a median follow-up of 108 months (range 14-184) 64 patients had recurrence of the tumor. Fifty-three died of the disease, two are currently alive with disease and nine were salvaged by surgery and/or chemotherapy. In a multivariate analysis only the tumor grade and the type of staging were significant independent prognostic factors for both disease-free and overall survival.
As described by other authors, we confirm that tumor grade is the single most important biological prognostic factor in early ovarian carcinoma. The thoroughness of the staging impacts significantly on survival, particularly in poorly differentiated carcinomas. Fertility-sparing surgery is not associated with a worse outcome than standard radical surgery.
已对Ⅰ期卵巢癌的多个预后因素进行了分析。其中一些因素本质上是生物学和临床方面的，但其他因素，如分期程序的彻底性、手术范围和治疗理念，则由人为因素决定。
我们回顾了1981年至1991年期间接受治疗的351例Ⅰ期卵巢癌患者的记录。所有患者均可获得以下信息：年龄、肿瘤大小、国际妇产科联盟（FIGO）分期、肿瘤分级、组织学类型、肿瘤破裂情况、细胞学检查、分期及手术范围（子宫全切术和双侧输卵管卵巢切除术与保留生育功能手术）以及辅助治疗的使用情况。分期的彻底性定义为：最佳分期：全腹子宫切除术和双侧输卵管卵巢切除术或保留生育功能手术、腹膜细胞学检查或冲洗、大网膜切除术、多处腹膜活检、腹膜后淋巴结取样或正规淋巴结清扫术；腹膜分期：满足上述所有标准，但不包括腹膜后取样；不完全分期：缺乏上述任何一项标准。
100例患者进行了最佳分期，107例进行了腹膜分期，144例进行了不完全分期。295名女性接受了根治性手术，56名接受了保留生育功能手术。中位随访时间为108个月（范围14 - 184个月），64例患者出现肿瘤复发。53例死于该疾病，2例目前仍患有疾病，9例通过手术和/或化疗得到挽救。在多变量分析中，只有肿瘤分级和分期类型是无病生存期和总生存期的重要独立预后因素。
正如其他作者所描述的，我们证实肿瘤分级是早期卵巢癌最重要的单一生物学预后因素。分期的彻底性对生存率有显著影响，特别是在低分化癌中。保留生育功能手术与标准根治性手术相比，预后并不更差。
