Distant metastases in ovarian carcinoma
Distant metastases in ovarian carcinoma
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DOI：
10.1046/j.1525-1438.2003.13054.x
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发表时间：
2003-03-01
影响因子：
4.8
通讯作者：
Selvaggi, L
中科院分区：
文献类型：
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作者：
Cormio, G;Rossi, C;Selvaggi, L
在卵巢癌的临床表现和病程中，远处转移是不常见的。本研究的目的是确定卵巢癌患者中与IV期疾病相一致的远处转移的发生率和预后因素。对1991~2000年间收治的162例卵巢上皮性癌患者的临床资料进行回顾性分析。收集相关的临床资料、病理资料、治疗和远处转移疾病记录后的生存预后因素。用标准卡方检验评估转移状态和各种临床变量之间的相关性的意义。生存时间从卵巢癌诊断时间和远处转移的诊断时间计算。在存在某些临床变量的情况下，使用Logistic回归程序估计转移状态的几率。在50例患者中，共有67个转移灶被诊断出来。确诊时有13例(8%)有远处转移，进展性疾病复发时有37例(22%)有远处转移。转移部位：肝脏21例，胸膜11例，肺8例，中枢神经系统和皮肤各7例，腹外淋巴结和脾各5例，骨2例，乳腺1例。卵巢癌的诊断和转移性疾病的记录之间的中位间隔时间为44个月(范围3-105)，在诊断远处疾病时，50名患者中有36名(72%)有其他病变部位(腹内或腹外)。诊断为远处疾病的中位生存期为12个月(范围1-58)。在单因素分析中(P=0.03)，其他病变部位的存在(P=0.04)和卵巢癌确诊到远处转移的间隔时间(P=0.03)是唯一与生存率显著相关的因素。多因素分析显示，间歇时间长对预后有显著影响(P=0.04)。与IV期疾病相一致的远处转移是一种晚期并发症，发生在大约三分之一的卵巢癌患者中。在记录到远处转移后，预后很差。我们得出结论，与生存相关的最重要的预后因素是卵巢癌诊断和远处转移记录之间的间隔时间。
Distant metastases are unusual at presentation and during the course of ovarian carcinoma. The aim of the present study was to determine the incidence and prognostic factors of distant metastases consistent with stage IV disease in ovarian cancer patients. A retrospective chart review was conducted on 162 patients with epithelial ovarian carcinoma treated at our Unit between 1991 and 2000. Pertinent clinical information, pathologic data, treatment, and prognostic factors for survival following documentation of distant metastatic disease were collected. The significance of the association between metastatic status and various clinical variables was assessed using the standard chi-square test. Survival time was calculated from the time of diagnosis of ovarian cancer and from the time of diagnosis of the distant metastases. A logistic regression procedure was used to estimate the odds of metastatic status given the presence of certain clinical variables. A total of 67 metastatic sites were diagnosed in 50 patients. Thirteen patients (8%) had distant metastatic disease at the time of diagnosis, 37 patients (22%) had distant metastases at the time of recurrent of progressive disease. Site of metastases were: liver, 21; pleura, 11; lung, 8; central nervous system and skin, 7 each; extra-abdominal lymph nodes and spleen, 5 each; bone, 2; and breast, 1. Significant risk factors for the development of distant metastases were stage, grade, and lymph node involvement. Median interval time between diagnosis of ovarian cancer and documentation of metastatic disease was 44 months (range 3-105), and at the time of diagnosis of distant disease, 36 of 50 patients (72%) had other sites of disease (intra-abdominal or extra-abdominal). Median survival from diagnosis of distant disease was 12 months (range 1-58). In univariate analysis performance status (P = 0.03 ), the presence of other sites of disease (P = 0.04 ) and interval time between diagnosis of ovarian cancer and documentation of distant metases (P = 0.03 ) were the only factors significantly associated with survival. Long interval time remained significant for prognosis in multivariate analysis also (P = 0.04 ). Distant metastasis consistent with stage IV disease is a late complication that occurs in about one third of ovarian cancer patients. Prognosis after documentation of distant metastases is poor. We conclude the most important prognostic factor associated with survival is the interval time between diagnosis of ovarian cancer and documentation of distant metastases.