Clinicopathologic characteristics and prognostic factors of ovarian fibrosarcoma: the results of a multi-center retrospective study.
Clinicopathologic characteristics and prognostic factors of ovarian fibrosarcoma: the results of a multi-center retrospective study.
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卵巢纤维肉瘤的临床病理特征及预后因素：多中心回顾性研究结果
DOI：
10.1186/1471-2407-10-585
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发表时间：
2010-10-27
期刊：
影响因子：
3.8
通讯作者：
Zheng M
中科院分区：
文献类型：
--
作者：
Huang L;Liao LM;Wang HY;Zheng M
卵巢纤维肉瘤是非常罕见的肿瘤，因此，很少有病例研究评估这种疾病的预后因素。据我们所知，本研究是评估卵巢纤维肉瘤患者临床和病理因素的最大规模研究。
回顾性分析了31例卵巢纤维肉瘤病例，其中包括8例患者的病历以及1995年至2009年发表的23例病例报告。患者的治疗方案包括全子宫切除术加双侧附件切除术和网膜切除术（BAO）（n = 9）、卵巢切除术（OR）（n = 8）、化疗（CT）（n = 1）、BAO后化疗（BAO + CT）（n = 11）、BAO后放疗（BAO + RT）（n = 1）以及卵巢切除术后放疗（OR + RT）（n = 1）。
该队列患者根据妇产科联合会（FIGO）的指南进行分期，分别确定了15例、6例、9例和1例I - IV期病例。还评估了10个高倍视野（HPFs）的有丝分裂计数，3例平均有丝分裂计数<4，18例在4 - 10之间，10例平均有丝分裂计数≥10。Ki - 67（MIB - 1）增殖指数值按如下分组：<10%（n = 5）、10% - 50%（n = 9）和≥50%（n = 5）。还检测到波形蛋白阳性表达（100%，22/22）和CD117阴性表达（0%，5/5）。此外，对所检查病例的子集报告了平滑肌肌动蛋白（2/18）、结蛋白（1/13）、上皮膜抗原（0/11）、S - 100（1/19）、CD99（0/6）、CD34（1/5）、α - 抑制素（7/15）、雌激素受体（1/6）和孕激素受体（1/6）的表达情况。中位随访14个月（范围2 - 120个月）后，所有患者的2年总生存率（OS）和无病生存率（DFS）分别为55.9%和45.4%。生存的Cox比例风险回归分析显示，FIGO分期（P = 0.007）和治疗（P = 0.008）可预测不良预后。此外，接受BAO + CT治疗的I期肿瘤患者预后较好。
有丝分裂活性和Ki - 67阳性细胞被确定为卵巢纤维肉瘤诊断的重要因素。此外，FIGO分期和治疗方式有可能成为生存的预后因素，BAO后辅助化疗与改善治疗结果相关。
BackgroundOvarian fibrosarcomas are very rare tumors, and therefore, few case studies have evaluated the prognostic factors of this disease. To our knowledge, this study represents the largest study to evaluate the clinical and pathologic factors associated with ovarian fibrosarcoma patients.MethodsThirty-one cases of ovarian fibrosarcoma were retrospectively reviewed, which included medical records for eight patients, and 23 published case reports from 1995 through 2009. Patient treatment regimens included total hysterectomy with bilateral adnexectomy and an omentectomy (BAO) (n = 9), oophorectomy (OR) (n = 8), chemotherapy (CT) (n = 1), BAO followed by chemotherapy (BAO+CT) (n = 11), BAO followed by radiotherapy (BAO+RT) (n = 1), and oophorectomy followed by radiotherapy (OR + RT) (n = 1).ResultsThe patients of this cohort were staged according to the guidelines of the Federation of Gynecology and Obstetrics (FIGO), with 15, 6, 9, and 1 stage I-IV cases identified, respectively. Mitotic count values were also evaluated from 10 high-power fields (HPFs), and 3 cases had an average mitotic count < 4, 18 cases were between 4 and 10, and 10 cases had an average mitotic count value ≥ 10. The Ki-67 (MIB-1) proliferation index values were grouped according to values that as follows: < 10% (n = 5), between 10% and 50% (n = 9), and ≥ 50% (n = 5). Positive expression of vimentin (100%, 22/22) and negative expression of CD117 (0%, 5/5) were also detected. Moreover, expression of smooth muscle actin (2/18), desmin (1/13), epithelial membrane antigen (0/11), S-100 (1/19), CD99 (0/6), CD34 (1/5), α-inhibin (7/15), estrogen receptor (1/6), and progesterone receptor (1/6) were reported for subsets of the cases examined. After a median follow-up period of 14 months (range, 2-120), the 2-year overall survival rates (OS) and disease-free survival (DFS) rates for all patients were 55.9% and 45.4%, respectively. Cox proportional hazard regression analysis of survival showed that FIGO stage (P= 0.007) and treatment (P= 0.008) were predictive of poor prognosis. Furthermore, patients with stage I tumors that received BAO+CT were associated with a better prognosis.ConclusionsMitotic activity, and cells positive for Ki-67 were identified as important factors in the diagnosis of ovarian fibrosarcoma. Furthermore, FIGO stage and treatment modalities have the potential to be prognostic factors of survival, with BAO followed by adjuvant chemotherapy associated with an improved treatment outcome.
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10.1046/j.1525-1438.2001.011004331.x
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2001-07-01
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