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目的探讨年轻卵巢上皮性癌患者的临床表现、病理类型、手术病理分期、治疗及预后。方法回顾性分析1986年1月至2002年3月间在我院治疗、年龄<30岁的卵巢上皮性癌21例患者的临床资料。结果21例患者确诊为卵巢上皮性癌时的中位数年龄为24岁(16～29岁),占同期全体卵巢上皮性癌患者的4.99%(21/421)。21例均在月经初潮后发病。12例有各种症状,腹痛8例、腹胀4例、月经改变3例等。21例中,急诊手术5例,16例为择期手术。肿物最大径线平均为17.6cm。16例肿瘤为单侧,4例为双侧,1例不详。手术病理分期,Ⅰ期10例、Ⅲ期5例、分期不详6例。病理类型以黏液性乳头状囊腺癌(9例)和浆液性乳头状囊腺癌(6例)最多见。病理分化程度,除6例不详外,高分化11例,中分化2例,低分化2例。初治时行肿瘤细胞减灭术或分期手术15例,复发后行再次肿瘤细胞减灭术6例;除2例患者外,肿瘤均切除干净或基本切除干净。共8例患者保留了生育功能。18例患者进行了以铂类或紫杉醇为基础药物的联合化疗,其中7例化疗达6个疗程以上。平均随访50个月(2～192个月)。结果6例患者死亡,2例带瘤生存,11例无瘤生存,2例失访。3年生存率为89%,5年生存率为76%。结论30岁以下妇女患卵巢上皮性癌较罕见,患者于月经初潮后发病,肿瘤体积较大,单侧多见;临床手术病理分期早期、病理分化程度高分化,病理类型以黏液性囊腺癌为多见,经手术及化疗,预后相对较好。
Objective To investigate the clinical manifestations, pathological types, surgical pathological staging, treatment and prognosis of young patients with epithelial ovarian cancer. Methods The clinical data of 21 patients with ovarian epithelial carcinoma aged <30 years who were treated in our hospital from January 1986 to March 2002 were retrospectively analyzed. Results The median age of 21 patients diagnosed with epithelial ovarian cancer was 24 years old (16-29 years old), accounting for 4.99% (21/421) of all ovarian epithelial cancer patients in the same period. All 21 cases developed after menarche. There were 12 cases of various symptoms, abdominal pain in 8 cases, abdominal distension in 4 cases, 3 cases of menstrual changes. In 21 cases, emergency surgery in 5 cases, 16 cases of elective surgery. The maximum diameter of the tumor was 17.6 cm. Sixteen tumors were unilateral, four were bilateral, and one was unknown. Surgical staging, Ⅰ stage in 10 cases, Ⅲ stage in 5 cases, stage unknown in 6 cases. Pathological types of mucinous papillary cystadenocarcinoma (9 cases) and serous papillary cystadenocarcinoma (6 cases) the most common. Pathological differentiation, in addition to six cases of unknown, well-differentiated in 11 cases, moderately differentiated in 2 cases, poorly differentiated in 2 cases. Initial treatment of tumor cytoreductive surgery or staging surgery in 15 cases, recurrence of tumor cytoreductive surgery again in 6 cases; except 2 patients, the tumor were removed or cleanly resected. A total of eight patients retained fertility. Eighteen patients underwent combined chemotherapy with either platinum or paclitaxel-based drugs, of which seven had more than six courses of chemotherapy. The average follow-up of 50 months (2 to 192 months). Results 6 patients died, 2 patients with tumor-free survival, 11 patients with tumor-free survival, 2 patients lost. The 3-year survival rate was 89% and the 5-year survival rate was 76%. Conclusions Women under the age of 30 have relatively rare epithelial ovarian cancer. Patients develop the disease after menarche. The tumor size is larger and unilateral is more common. In the early stage of clinical surgery, the pathological differentiation is highly differentiated. The pathological type is mucinous cystadenocarcinoma As more common, after surgery and chemotherapy, the prognosis is relatively good.