2015 年第 5 期 第 13 卷

136例原发性卵巢透明细胞癌临床病理特征及预后分析

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关键词：卵巢肿瘤腺癌，透明细胞病理学，临床诊断治疗预后

• 摘要：
• 【摘要】目的 探讨卵巢透明细胞癌(OCCA)的临床病理特征和预后。方法 回顾性分析1984年6月至2014年6月首都医科大学附属北京妇产医院诊治的136例OCCA患者的临床资料，分析患者的临床病理特征与预后的关系。采用Cox比例风险回归模型分析影响患者预后的因素。结果 136例OCCA患者中位发病年龄48岁(23岁～74岁)。本组患者总体5年生存率为40.8%，其中I、II、III、IV期分别为70.7%、66.4%、15.9%、0。FIGO分期：I、II、III、IV期分别为47.1% (64/136)、11.8% (16/136)、33.8% (46/136)、7.4% (10/136)。合并子宫内膜异位症38例(38/136，27.9%)。复发率41.9%(40/136)。单因素分析结果显示，FIGO分期、是否合并子宫内膜异位症、淋巴结转移、残存肿瘤大小、足够的化疗疗程、无进展时间(PFI)是影响患者预后的因素（均P＜0.05），而患者发病年龄、腹水/腹腔冲洗液细胞学结果、盆腔肿物大小和不同的化疗方案与预后无关（均P＞0.05）。多因素分析结果显示，PFI是OCCA预后的独立影响因素(P＜0.05)。结论：OCCA以早期患者多见，易合并子宫内膜异位症，易复发，预后差。OCCA患者行理想肿瘤细胞减灭术，术后足够疗程的化疗可望改善预后。PFI是OCCA预后的独立影响因素
• Objective To investigate the clinicopathological features and prognosis of ovarian clear cell adenocarcinoma(OCCA) and to improve the diagnosis, treatment and prognosis of this disease. Methods The clinicopathological data of 136 patients with OCCA treated in our hospital between June 1984 and June 2014 were analyzed retrospectively. Results Median age at diagnosis was 48 years (range 23～74 years). The overall 5-year survival rate was 40.8%，70.7% in stage I，66.4% in stage II，15.9% in stage III，0 in stage IV，respectively. Tumors were 47.1% (64/136) stage I，11.8% (16/136) stage II，33.8% (46/136) stage III，and 7.4% (10/136) stage IV. There were 38 (38/136，27.9%) patients with endometriosis. The recurrence rate was 41.9%(40/136). Univariate analysis showed that the FIGO staging(P=0.000)，combined with endometriosis(P=0.012)，lymphatic metastasis(P=0.010)，residual tumor diameter(P=0.000)，sufficient chemotherapeutic cycles(P=0.000) and progression free interval (PFI) (P=0.000) were impact factors, while age of patients at diagnosis (P=0.610)，peritoneal cytological status (P=0.054)，tumor diameter (P=0.800) and differences of chemotherapy regimes (P=0.903) were not. Cox multivariate analysis showed that PFI was independent prognostic factors for OCCA (P＜0.05). Conclusion: OCCA patients are often of early stage at diagnosis，with poor prognosis，easy recurrence，more combination with endometriosis. Our results suggest that optimal cytoreductive surgery and sufficient postoperative chemotherapy can improve the prognosis of patients with OCCA. PFI is an individual prognostic factor for survival of OCCA