Comparison of secondary and primary ovarian malignancies reveals differences in their pre- and perioperative characteristics
Comparison of secondary and primary ovarian malignancies reveals differences in their pre- and perioperative characteristics
复制标题
DOI：
10.1016/j.ygyno.2005.09.046
复制
发表时间：
2006-04-01
影响因子：
4.7
通讯作者：
Heikinheimo, O
中科院分区：
文献类型：
--
作者：
Antila, R;Jalkanen, J;Heikinheimo, O
Objective.术前鉴别原发性和转移性卵巢肿瘤是困难的。继发性卵巢恶性肿瘤的特点是患者年龄小、双侧性和多房性减少。我们试图确定术前和围手术期的因素，这些因素可能有助于区分转移性卵巢肿瘤和原发性卵巢恶性肿瘤。我们对38例继发性卵巢恶性肿瘤患者和76例原发性上皮性卵巢癌对照患者的人口统计学参数、术前血清肿瘤标志物水平、超声检查以及手术结果进行了回顾性分析。所有患者均于1996 ~ 2003年在我院治疗。继发性卵巢肿瘤占所有卵巢恶性肿瘤的5.2%。最常见的起源部位是胃肠道（42%）、乳房（29%）和腹膜（16%）。58%的继发性卵巢肿瘤患者有既往恶性肿瘤史; 42%的原发性恶性肿瘤仅在诊断为卵巢转移后才被发现。两个患者组（原发性或继发性卵巢恶性肿瘤）不能通过年龄、产次、绝经状态或子宫切除术史来区分。血清标志物中，术前血清CA 125水平在两组之间无差异。血清肿瘤相关胰蛋白酶抑制剂（TATI）（7.2 +/- 9.6 vs. 4.7 +/- 9.4 μ g/l [平均值+/- SD]）和癌胚抗原（CEA）水平（19.7 +/- 30.8 vs. 6.7 120.0 μ g/l）在继发性恶性肿瘤组中均较高（P < 0.02）。术前通过超声（US）测量的转移性卵巢肿瘤（64 mm，62-89 mm [中位数，95% CI]）小于原发性肿瘤（105 mm，104-134 mm）（P < 0.0005）。手术时测量的肿瘤大小也是如此（P < 0.05）。继发性肿瘤以实性为主（50比10%）（P < 0.005），囊实性少见（17比55%）（P < 0.001）。原发性卵巢恶性肿瘤患者在术前超声检查（P < 0.01）和手术时（P < 0.0001）均较常出现腹水。两组间双侧粘连、粘连和癌变无差异。当评估卵巢肿瘤患者时，恶性肿瘤史强烈提示转移性。肿瘤体积小于9 cm、实性结构、无腹水、血清CEA和TATI水平升高是继发性卵巢恶性肿瘤的典型特征。(C)2005年爱思唯尔公司All rights reserved.
Objective. Preoperative differentiation of primary and metastatic ovarian tumors is difficult. Young age of the patient, bilateralism and reduced multilocularity are cited characteristics of secondary ovarian malignancies. We sought to identity pre- and perioperative factors which may aid in differentiating metastatic ovarian tumors from primary ovarian malignancies.Patients and methods. We performed a retrospective analysis of demographic parameters, preoperative serum tumor marker levels and ultrasonographic as well as operative findings in 38 patients with secondary ovarian malignancies and 76 control patients with primary epithelial ovarian cancer. All patients were treated at our institute from 1996 to 2003.Results. The proportion of secondary ovarian tumors, of all ovarian malignancies, was 5.2%. The most common sites of origin were the gastrointestinal tract (42%), breast (29%) and peritoneum (16%). Fifty-eight percent of the patients with a secondary ovarian tumor had a history of previous malignancy; 42% of the primary malignancies were detected only following diagnosis of ovarian metastasis. The two patient groups (primary or secondary ovarian malignancy) could not be distinguished by age, parity, menopausal status or history of hysterectomy. Of the serum markers, the preoperative level of serum CA 125 was not different between the two groups. Both serum tumor-associated trypsin inhibitor (TATI) (7.2 +/- 9.6 vs. 4.7 +/- 9.4 mu g/l [mean +/- SD]) and carsinoembryonic antigen (CEA) levels (19.7 +/- 30.8 vs. 6.7 120.0 mu g/l) were higher in the group with secondary malignancies (P < 0.02). The metastatic ovarian tumors, as measured preoperatively by ultrasonography (US), were smaller (64 mm, 62-89 mm [median, 95% Cl]) than the primary tumors (105 mm, 104-134 mm) (P < 0.0005). The same was true for tumor sizes measured at surgery (P < 0.05). Furthermore, the secondary tumors were more often solid (50 vs. 10%) (P < 0.005), and more seldom cystic-solid (17 vs. 55%) (P < 0.001). Presence of ascites was more common among patients with primary ovarian malignancies in both preoperative US (P < 0.01) and at operation (P < 0.0001). Bilateralism, presence of adhesions, and carcinosis did not differ between the two groups.Conclusions. When evaluating a patient with an ovarian tumor, a history of malignancy strongly suggests a metastatic nature. Size less than 9 cm, solid structure, absence of ascites and elevated serum CEA and TATI levels were typical features associated with secondary ovarian malignancies. (C) 2005 Elsevier Inc. All rights reserved.