Clinicopathologic analysis of early-stage sporadic ovarian carcinoma
Clinicopathologic analysis of early-stage sporadic ovarian carcinoma
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DOI：
10.1097/00000478-200402000-00001
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发表时间：
2004-02-01
影响因子：
5.6
通讯作者：
Soslow, RA
中科院分区：
文献类型：
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作者：
Leitao, MM;Boyd, J;Soslow, RA
早期(FIGO I/II期)卵巢癌(OC)的报道经验是有限的，因为大多数OC妇女是在晚期被诊断出来的。目前还没有对这些肿瘤进行广泛的综述，而且由于区分侵袭性和交界性肿瘤的病理标准随着时间的推移而演变，因此是否应该对其中一部分肿瘤进行重新分类的问题尚未解决。我们确定了1980-2000年间在纪念斯隆-凯特琳癌症中心接受初级手术治疗的I/II期侵袭性OC患者。已知有BRCA突变或有乳腺癌/卵巢癌家族史的患者被排除在外。采用目前卵巢癌和交界性卵巢肿瘤的诊断标准，对临床结果盲目进行苏木素和曙红玻片回顾。评估并比较无进展生存率(PFS)和疾病特异性生存率(DSS)。对145例确诊患者中的140例进行了苏木精和曙红切片检查。诊断为交界性(低恶性潜能)者41例(29.3%)。在41个诊断变化中，29个(70.7%)涉及子宫内膜样癌和粘液性肿瘤。这归因于最近修订的区分交界性肿瘤和癌症的标准的应用。最初诊断的透明细胞癌没有一例被重新归类为交界性癌。其中浆液性癌26例(27.7%)，透明细胞癌25例(26.6%)，子宫内膜样癌22例(23.4%)，混合型10例(10.6%)，粘液型6例(6.4%)，恶性Brenner癌2例(2.1%)，腺癌3例(3.2%)。94例肿瘤患者中84例(89.4%)接受了辅助治疗。被重新分类为临界组的5年无症状生存时间和无症状生存时间显著增加(进展4.5%比26.2%[P=0.006]；死亡4.5%比25.6%[P=0.003])。携带TP53基因突变的癌症患者的5年PFS和DSS显著恶化(进展22.6%比41.2%[P=0.04]；死亡21.7%比24.7%[P=0.04])。在I期和II期、肿瘤分级、透明细胞组织学和IC期术前破裂与术中破裂之间的结果没有统计学意义上的差异。我们的结论是，大量最初被诊断为早期散发性OC的病例是交界性肿瘤。与其他组织学相比，透明细胞组织学并不意味着预后更差。TP53突变的存在是一个不利的预后指标。
The reported experience with early-stage (FIGO stage I/II) ovarian carcinoma (OC) is limited given that the majority of women with OC are diagnosed at an advanced stage. There has not been an extensive review of these tumors, and since the pathologic criteria differentiating invasive and borderline tumors have evolved over time, the issue of whether a proportion of these tumors should be reclassified has not been addressed. We identified patients with stage I/II invasive OC who underwent primary surgical management at Memorial Sloan-Kettering Cancer Center from 1980 to 2000. Patients known to have a BRCA mutation or a family history of breast/ovarian cancer were excluded. Hematoxylin and eosin slide review, blinded to clinical outcomes, using current diagnostic criteria for ovarian carcinomas and borderline ovarian tumors, was performed. Progression-free survival (PFS) and disease-specific survival (DSS) were estimated and compared. Hematoxylin and eosin slides were reviewed for 140 of the 145 patients identified. The diagnosis was changed to borderline (low malignant potential) in 41 cases (29.3%). Twenty-nine (70.7%) of 41 changes in diagnosis involved endometrioid and mucinous tumors. This was attributable to the application of recently revised criteria for distinguishing borderline tumors from carcinomas. None of the originally diagnosed clear cell carcinomas was reclassified as borderline. The distribution of histologic subtypes among the 94 carcinomas included 26 serous (27.7%), 25 clear cell (26.6%), 22 endometrioid (23.4%), 10 mixed (10.6%), 6 mucinous (6.4%), 2 malignant Brenner (2.1%), and 3 adenocarcinomas, not otherwise specified (3.2%). Adjuvant therapy was given to 84 (89.4%) of the 94 patients with carcinomas. The 5-year PFS and DSS were significantly greater for the group of cases that was reclassified as borderline (4.5% vs. 26.2% progressed [P = 0.006]; 4.5% vs. 25.6% died [P = 0.003]). The 5-year PFS and DSS were significantly worse for carcinomas with a TP53 mutation (22.6% vs. 41.2% progressed [P = 0.04]; 21.7% vs. 24.7% died [P = 0.04]). There were no statistically significant differences in outcome between stages I versus II, tumor grades, clear cell histology versus other, and stage IC preoperative versus intraoperative rupture. We concluded that a large number of cases originally diagnosed as early-stage sporadic OC were borderline tumors. Clear cell histology does not confer a worse prognosis compared with other histologies. The presence of a TP53 mutation was an adverse prognostic indicator.