CAJ | 학술논문

目的探讨卵巢上皮性癌(卵巢癌)脾转移的临床病理特点,分析脾切除术作为卵巢癌肿瘤细胞减灭术的一部分的可行性及预后因素.方法采用回顾性研究方法,收集1998年1月至2006年6月在浙江省肿瘤医院行包括脾切除的肿瘤细胞减灭术的32例卵巢癌患者,对其临床病理及随访资料进行分析.结果浆液性腺癌为23例(72%),9例(28%)为非浆液性腺癌;病理分级:G1 0例,G2 11例(34%),G3 21例(66%).术后20例无肉眼可见残余肿瘤,7例残余肿瘤直径≤2 cm,5例残余肿瘤直径＞2 cm.手术并发症发生率为25%(8/32),包括脾窝脓肿、腹壁切口感染、胃瘘、应激性胃溃疡、静脉血栓、不全肠梗阻等.中位随访时间为38个月(1～74个月),中位生存时间为50.9个月,2年、5年生存率分别为70%、36%.单因素分析显示病理分级、残余肿瘤有无、化疗疗程数影响预后(P均＜0.05);多因素分析显示,仅残余肿瘤有无及化疗疗程数与预后有关(P均＜0.05).结论卵巢癌脾转移最常见的病理类型为低分化浆液性腺癌.对于卵巢癌脾转移患者,脾切除术作为肿瘤细胞减灭术的一部分是安全、有效的治疗方法;术后残余肿瘤有无、化疗疗程数是独立的预后因素.
목적 탐토란소상피성암(란소암)비전이적림상병리특점,분석비절제술작위란소암종류세포감멸술적일부분적가행성급예후인소.방법 채용회고성연구방법,수집1998년1월지2006년6월재절강성종류의원행포괄비절제적종류세포감멸술적32례란소암환자,대기림상병리급수방자료진행분석.결과 장액성선암위23례(72%),9례(28%)위비장액성선암;병리분급:G1 0례,G2 11례(34%),G3 21례(66%).술후20례무육안가견잔여종류,7례잔여종류직경≤2 cm,5례잔여종류직경＞2 cm.수술병발증발생솔위25%(8/32),포괄비와농종、복벽절구감염、위루、응격성위궤양、정맥혈전、불전장경조등.중위수방시간위38개월(1～74개월),중위생존시간위50.9개월,2년、5년생존솔분별위70%、36%.단인소분석현시병리분급、잔여종류유무、화료료정수영향예후(P균＜0.05);다인소분석현시,부잔여종류유무급화료료정수여예후유관(P균＜0.05).결론 란소암비전이최상견적병리류형위저분화장액성선암.대우란소암비전이환자,비절제술작위종류세포감멸술적일부분시안전、유효적치료방법;술후잔여종류유무、화료료정수시독립적예후인소.
Objective To investigate the clinicopathologic features,the complications of splenectomy and the survival of epithelial ovarian cancer patients with splenic metastasis.Methods A retrospective study was performed of 32 pailents with epithelial ovarian cancer who underwent splenectomy for tumor cytoreduction at Zhejiang Cancer Hospital between Jan 1998 and Jun 2006.Results Of 32 patients,23 patients(72%)were serous adenocarcinoma and 9 were non-serous adenocarcinoma.According to pathological grade,none was of G1,11 were of G2,21 were of G3.Postoperatively,20 patients were left with no residual tumor.7 were with≤2 cm and 5 were with＞2 cm residual tumor.Postoperative complications developed in 8 patients(25%),including subphrenic abscess,wound infection,gastric perforation,gastrorrhagia,phlebothrombosis,and bowel obstruction.The median follow up was 38 months,estimated 2-year and 5-year overall survival were 70%and 36%.Univariate analysis revealed that histological grade,residual tumor and courses of chemotherapy were influencing factors of the survival(P＜0.05),but multivariate analysis indicated that only residual tumor and courses of chemotherapy independently influenced survival(P＜0.05).Conclusions In epithelial ovarian cancer patients with splenic metastasis,low grade serous adenocarcinoma is most common.Splenectomy as part of cytoreductive surgery is associated with modest morbidity and mortality.Residual tumor and courses of chemotherapy are independent factors associated with the prognosis of the patients.