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頁籤選單縮合
題名 | Epithelial Ovarian Tumors of Borderline Malignancy=邊緣惡性卵巢上皮腫瘤 |
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作者 | 趙德明; 顏明賢; 趙灌中; 吳香達; Chao, Teh-ming; Yen, Ming-shyen; Chao, Kuan-chong; Ng, Heung-tat; |
期刊 | 中華醫學雜誌 |
出版日期 | 19960800 |
卷期 | 58:2 1996.08[民85.08] |
頁次 | 頁97-102 |
分類號 | 417.25 |
語文 | eng |
關鍵詞 | 邊緣惡性; 卵巢; Borderline malignancy; Ovary; |
中文摘要 | 背景 邊緣惡性卵巢上皮腫瘤的特性,和卵巢良性及惡性腫瘤不同。 它們和侵犯性惡性癌症相比,有較溫和的臨床過程,平均發病年齡較輕,以及 有較好的預後。大部份這類腫瘤在第一期上時就會被發現。這篇回溯性文章主 要目的是回顧台北榮民總醫院48個被診斷為邊緣惡性卵巢上皮腫瘤病例,她們 發病的臨床過程、治療方式及預後。 方法 自西元1980年1月到西元1992年12月,榮民總醫院共有48位病人被 診斷為邊緣惡性卵巢腫瘤,發病年齡介於14歲到69歲(平均年齡為39.2歲)。 組織病理診斷標準主要根據西元1985年Tazelaar et al.發表的診斷邊緣惡性卵巢 腫瘤外形標準一文。所有病人的資料,包括臨床分期、手術方式、預後情形, 是根據舊有病歷資料及聯絡病人回來門診複診所得到的。有兩位病人出院後沒 有再回門診複診,一人在兩年後發生另外一種癌症,在評估預後時被排除在外。 腫瘤分期是依照FIGO標準採手術分期。 結果 48位病人中有39人(81.3%)是一期上,6位病人(12.5%)為一期中,2位 病人(4.1%)為一期下,另外一位(2.1%)為第三期下。34位病人(71%)是黏液性邊 緣惡性卵巢腫瘤,11位病人(23%)是漿液性,3位病人(6%)為混合黏液及漿液性 卵巢瘤。22位病人接受腹式全子宮及兩側卵巢輸卵管切除,12位病人接受單側 卵巢或單側卵巢輸卵管切除,12位病人除單側卵巢輸卵管切除外,再加上對側 卵巢楔狀切片,1位病人接受根除性廓清手術,1位病人接受卵巢瘤摘除術及對 側卵巢楔狀切片。18位病人術後追加化學治療。3位病人接受再次剖腹探查, 沒有一人有復發跡象。一位病人復發,另一人發生另一種癌症,她後來死於再 次手術併發症。有45位病人預後良好,她們追蹤時間介於1年到14年(平均4 年)。 結論 邊緣惡性卵巢囊腫的大部份病人最初診斷時多在疾病早期,依據我們的 資料,81.3%的病人是一期上,只有一年是三期下。63%的病人只接受手術切除, 其餘37%接受手術後化學治療。如果病人為早期腫瘤而希望保有生殖能力,則 可只做單側卵巢輸卵管切除或是腫瘤切除。但這種手術治療方式,因復發率較 高,必須進行密切術後定期追蹤,若有復發跡象,則需進一步及早治療。只接 受手術治療的存活率(100%)和術後再加上化學治療的存活率(100%)並沒有差 別。低復發率(2%)再次證明此種疾病的良性過程。而對側卵巢是否應做楔狀切 除,仍有爭議。關於輔助性化學治療的效果,尚須更多有計畫前瞻性研究來加 以評估。 |
英文摘要 | Background. Epithelial ovarian tumors of borderline malignancy are different from benign tumors and malignant neoplasms. They exist with relatively benign clinical course, younger age and better prognosis as compared with invasive malignant carcinomas. Most of them are discovered at early stage, for example, stage Ia. This retrospective review evaluates the clinical features, treatments and prognosis of 48 patients with borderline malignancy of ovarian tumors. Methods. Forty-eight patients with ovarian tumors of borderline malignancy, aged from 14 to 69 years (mean: 39.2 years; median: 36 years), were retrospectively studied. The histopathologic diagnosis was based on the morphologic criteria published by Tazelaar et al. in 1985. All cases, including 16 cases diagnosed before 1985, were pathologically reviewed. All information of clinical stage, surgical intervention and prognosis was achieved by reviewing hospital record or contacting patients by telephone. Two patients were lost to follow up. One patient died of sepsis resulting from another operation for another gynecological cancer. Totally forty-five patients were included for evaluation. Results. Thirty-nine of the 48 patients (81.3%) were at stage Ia, 6 cases (12.5%) were at stage Ib, 2 cases (4.1%) were at stage Ic, and the remaining one patient (2.1%) was at stage IIIc. Thirty-four patients (71 %) were with mucinous cystadenoma of borderline malignancy, 11 cases (23%) were of serous type, and 3 patients (6%) were of mixed serous and mucinous type. Twenty-two patients underwent total abdominal hysterectomy and bilateral salpingo-oophorectomy (TAH and BSO), but one of them remained partial ovary due to young age (27 y/o). Twelve patients were treated with unilateral oophorectomy or unilateral salpingooophorectomy (USO). Twelve patients underwent USO and wedge resection of contralateral ovary. One case underwent debulking surgery. One patient underwent enucleation of ovarian tumor and biopsy of contralateral ovary. Eighteen patients were treated with chemotherapy after operation. One patient developed recurrence 4 months after the primary operation. Excluding two cases lost to follow up and one case with surgical mortality for another gynecological cancer, forty-five patients were alive and were followed from 9 months to 165 months. (median: 48 months; mean: 46 months) Conclusions. Most of the patients were at the early stage of disease when first diagnosed, 81.3% were at stage Ia and only one case was at stage IIIc. Sixty-three percent of our patients underwent surgical treatment alone while the rest of them (37%) had post-operative chemotherapy with either alkeran or PAC. The use of adjuvant chemotherapy seemed unwarranted as there was no difference in survival between those with and without it. (p > 0.05) The low recurrent rate of 2% in our patients again confirmed the 9 P relative benign clinical course of this disease. |
本系統之摘要資訊系依該期刊論文摘要之資訊為主。