中国癌症杂志 ›› 2019, Vol. 29 ›› Issue (9): 723-729.doi: 10.19401/j.cnki.1007-3639.2019.09.007

• 论著 • 上一篇    下一篇

101例原发性输卵管癌临床特点及预后影响因素分析

孙洺洺 1 ,包灵洁 1 ,易晓芳 1,2 ,徐丛剑 1,2 ,姜 伟 1,2   

  1. 1. 复旦大学附属妇产科医院妇科,上海 200011 ;
    2. 上海市女性生殖内分泌相关疾病重点实验室,上海 200011
  • 出版日期:2019-09-30 发布日期:2019-11-20
  • 通信作者: 姜 伟 E-mail: jw52317@126.com

Retrospective analysis of clinical characteristics and prognostic factors in 101 patients with primary fallopian tube carcinoma

SUN Mingming 1 , BAO Lingjie 1 , YI Xiaofang 1, 2 , XU Congjian 1, 2 , JIANG Wei 1, 2   

  1. 1. Department of Gynecology, Obstetrics and Gynecology Hospital, Fudan University, Shanghai 200011, China; 2. Shanghai Key Laboratory of Female Reproductive Endocrine Related Diseases, Shanghai 200011, China
  • Published:2019-09-30 Online:2019-11-20
  • Contact: JIANG Wei E-mail: jw52317@126.com

摘要: 背景与目的:原发性输卵管癌(primary fallopian tube carcinoma,PFTC)是女性罕见的恶性肿瘤,目前国内外报道较少。分析PFTC临床特点并探讨影响其预后的相关因素。方法:回顾性分析2002年1月—2017年12月复旦大学附属妇产科医院收治的101例经手术后病理学确诊的PFTC患者的临床病理学资料并对预后进行随访,随访时间为5~141个月,平均随访时间为60.54个月,以年龄、绝经状态、生育史、输卵管结扎史、乳腺癌病史、临床症状、术前血清CA125水平、术前影像学表现、腹水细胞学检测、临床手术病理学分期、是否行盆腔淋巴结清扫术、是否为满意的瘤体减灭术(残余瘤直径≤1.0 cm)、肿瘤组织病理学类型、肿瘤大小、免疫组织化学检测结果、术后化学治疗的疗程作为变量。应用Kaplan-Meier法计算并分析其总生存率及无进展生存率,应用Log-rank进行单因素分析检验,应用COX回归模型进行多因素分析,研究这些因素与患者总生存期(overall survival,OS)及无进展生存期(progression-free survival,PFS)之间的关联。结果:101例PFTC患者的5年总生存率为79.3%,平均OS为91.89个月(95% CI:81.90~101.88),中位OS为100个月(95%CI:93.94~106.07)。5年无进展生存率为71.6%,平均PFS为89.47个月[95% CI:78.80~100.14],中位PFS为98个月(95%CI:77.69~118.31)。最常见的临床表现是附件肿块(36.6%),其次是阴道流血(14.9%),无特殊症状患者占10.9%。85例(84.2%)患者获得满意的瘤体减灭术(残余瘤直径≤1 cm),16例(15.8%)患者获得次满意的瘤体减灭术。肿瘤组织学亚型主要为浆液型癌(91.1%)。术后诊断Ⅰ/Ⅱ期患者61例(60.4%),Ⅲ/Ⅳ期患者40例(39.6%)。至末次随访日,全组患者复发率为43.6%。单因素变量分析及多因素变量分析显示,国际妇产科联盟(International Federation of Gynecology and Obstetrics,FIGO)分期(P<0.001;HR=4.58;95% CI:2.361~8.882)、是否行盆腔淋巴结清扫(P=0.002;HR=0.338;95% CI:0.170~0.673)及残余肿瘤情况(P<0.001;HR=4.655;95% CI:2.007~10.794)是显著的预后因素,而其他变量差异无统计学意义。结论:PFTC难以在术前得到明确诊断,其独特的生物学特征及发病机制仍处于研究当中,FIGO分期、是否行盆腔淋巴结清扫及残余肿瘤情况是影响PFTC患者预后的主要因素。

Abstract: Background and purpose: Primary fallopian tube carcinoma (PFTC) is a rare female malignant tumor, and the diagnosis of PFTC is rarely considered preoperatively. It is an infrequent disease and hardly reported. In this study, we analyzed clinical characteristics in 101 PFTC patients and identified the prognostic factors for the disease. Methods: We reviewed medical records of patients with PFTC at the Obstetrics and Gynecology Hospital of Fudan University from January 2002 to December 2017. The data included age, menopause status, childbearing history, tubal ligation history, breast cancer history, symptom, pretreatment CA125 level, imaging findings, ascitic cytology, debulking surgery or not, pelvic lymphadenectomy or not, surgical stage, pathologic subtype, tumor diameter, immunohistochemistry and chemotherapeutic course. The mean follow-up time was 60.54 months (ranging from 5 to 141 months). The Kaplan-Meier method was used to measure the overall survival and progression-free survival. A Log-rank univariate analysis was used to determine the prognostic factors related to the survival rate. The COX model multivariate analysis was used to identify independent prognostic factors. Results: A total of 101 patients with PFTC were identified. The 5-year overall survival was 79.3%, the mean overall survival was 91.89 months (95% CI: 81.90-101.88), and the median overall survival was 100 months (95% CI: 93.94-106.07). The 5-year progression-free survival was 71.6%, the mean progression-free survival was 89.47 months (95% CI: 78.80-100.14), and the median progression-free survival was 98 months (95% CI: 77.69-118.31). The most common clinical presentation was adnexal mass (36.6%), followed by vaginal bleeding (14.9%) and no specific symptom (10.9%). Residual disease was optimal in 85 (84.2%) patients and suboptimal in 16 (15.8%) patients. The histological subtype was predominantly the serous type (91.1%). Sixty-one patients (60.4%) were diagnosed at Stage Ⅰ/Ⅱ postoperatively. Forty (39.6%) patients were in Stage Ⅲ/Ⅳ. Until the end of follow-up time, the recurrence rate of the group was 43.6%. Univariate analyses on overall survival revealed that the International Federation of Gynecology and Obstetrics (FIGO) stage (P<0.001; HR=4.58; 95% CI: 2.361-8.882), with or without pelvic lymphadenectomy (P=0.002; HR=0.338; 95% CI: 0.170-0.673) and residual tumor (P<0.001; HR=4.655; 95% CI: 2.007-10.794) were significant prognostic factors. Conclusion: The diagnosis of PFTC is rarely considered preoperatively. Its unique biological features and pathogenesis are still under study. FIGO staging, pelvic lymphadenectomy and residual tumor are the main factors affecting the prognosis of patients with PFTC.