Outcome of reproductive age women with stage IA or IC invasive epithelial ovarian cancer treated with fertility-sparing therapy
Outcome of reproductive age women with stage IA or IC invasive epithelial ovarian cancer treated with fertility-sparing therapy
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DOI：
10.1006/gyno.2002.6805
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发表时间：
2002-10-01
影响因子：
4.7
通讯作者：
van Nagell, J
中科院分区：
文献类型：
--
作者：
Schilder, JM;Thompson, AM;van Nagell, J
目标。本研究的目的是确定IA期和IC期侵袭性上皮性卵巢癌患者接受单侧附件切除治疗的复发率、生存率和妊娠结局。一项多机构的回顾性研究确定了接受保留生育能力手术治疗的IA期和IC期上皮性卵巢癌患者。排除卵巢交界性恶性肿瘤患者。通过肿瘤登记和电话访谈进行长期随访。记录每位患者肿瘤复发的时间和部位、患者生存期及妊娠结局。从1965年到2000年，在8个参与研究的机构中确定了52例I期上皮性卵巢癌患者。42名患者患有IA期癌症，10名患有IC期癌症。细胞类型分布如下：黏液型，25；浆液性、10;endometrioid 10;透明细胞，5；混合后是2。组织学分化：1级、38级；二、九年级；3年级，5年级。辅助化疗20例（平均6个疗程，范围3 ~ 12个疗程）。患者接受以下化疗药物：顺铂/紫杉醇或卡铂/紫杉醇，11；美法仑,5;顺铂和环磷酰胺，3；单药顺铂，1。8例患者复诊，结果均为阴性。随访时间6 ~ 426个月（中位68个月）。5例患者术后8 ~ 78个月肿瘤复发。复发部位：对侧卵巢3例；腹膜,1;肺，1。9例患者因良性疾病行子宫切除术和对侧卵巢切除术。目前，50名患者存活，无疾病证据，2名患者在初次治疗后13个月和97个月死于疾病。估计5年生存率为98%，10年生存率为93%。24例患者尝试妊娠，17例（71%）成功妊娠。17例足月分娩26例（无先天性异常），自然流产5例。单侧附件切除术治疗的IA期和IC期上皮性卵巢癌患者的长期生存率非常好。保留生育能力的手术应被视为希望进一步生育的I期上皮性卵巢癌妇女的一种治疗选择。(C) 2002 Elsevier Science （USA）。
Objectives. The purpose of this study was to determine the recurrence rate, survival, and pregnancy outcome in patients with Stage IA and Stage IC invasive epithelial ovarian cancer treated with unilateral adnexectomy.Methods. A multi-institutional retrospective investigation was undertaken to identify patients with Stage IA and IC epithelial ovarian cancer who were treated with fertility-sparing surgery. All patients with ovarian tumors of borderline malignancy were excluded. Long-term follow-up was obtained through tumor registries and telephone interviews. The time and sites of tumor recurrence, patient survival, and pregnancy outcomes were recorded for every patient.Results. Fifty two patients with Stage I epithelial ovarian cancer treated from 1965 to 2000 at 8 participating institutions were identified. Forty-two patients had Stage IA disease, and 10 had Stage IC cancers. Cell type was distributed as follows: mucinous, 25; serous, 10; endometrioid, 10; clear cell, 5; and mixed, 2. Histologic differentiation was as follows: grade 1, 38; grade 2, 9; and grade 3, 5. Twenty patients received adjuvant chemotherapy (mean 6 courses, range 3-12 courses). Patients received the following chemotherapeutic agents: cisplatin/taxol or carboplatin/taxol, 11; melphalan, 5; cisplatin and cyclophosphamide, 3; and single-agent cisplatin, 1. Eight patients had second-look laparotomies and all were negative. Duration of follow-up ranged from 6 to 426 months (median 68 months). Five patients developed tumor recurrence 8-78 months after initial surgery. Sites of recurrence were as follows: contralateral ovary, 3; peritoneum, 1; and lung, 1. Nine patients underwent subsequent hysterectomy and contralateral oophorectomy for benign disease. At present, 50 patients are alive without evidence of disease and 2 have died of disease 13 and 97 months after initial treatment. The estimated survival was 98% at 5 years and 93% at 10 years. Twenty-four patients attempted pregnancy and 17 (71%) conceived. These 17 patients had 26 term deliveries (no congenital anomalies noted) and 5 spontaneous abortions.Conclusion. The long-term survival of patients with Stage IA and IC epithelial ovarian cancer treated with unilateral adnexectomy is excellent. Fertility-sparing surgery should be considered as a treatment option in women with Stage I epithelial ovarian cancer who desire further childbearing. (C) 2002 Elsevier Science (USA).