目的探讨合并卵巢子宫内膜异位症(内异症)的卵巢上皮性癌(卵巢癌)的临床病理特点。方法选取1996年1月至2006年12月在复旦大学附属妇产科医院就诊并经手术确诊的卵巢癌共727例,对其中合并卵巢内异症的67例患者(其中由卵巢内异症恶变的卵巢癌患者34例,为A组;其他仅合并卵巢内异症的卵巢癌患者33例,为B组)的临床病理资料进行回顾性分析,并与660例未合并卵巢内异症的卵巢癌患者(C组)进行对照分析。同期本院经手术病理确诊的卵巢内异症患者共3890例。结果卵巢内异症恶变为卵巢癌的发生率为0.87%(34/3890)。卵巢癌合并卵巢内异症的发生率为9.2%(67/727)。A、B、C组患者的平均年龄分别为(47.2±1.3)、(47.8±1.2)、(51.2±0.4)岁,3组间比较,差异有统计学意义(P=0.013)。A、B组病理类型多为透明细胞癌(分别为67.6%、69.7%),其所占比例均明显高于C组的18.8%(P=0.000);而C组以浆液性腺癌(50.3%)为主,其所占比例明显高于A组的8.8%和B组的12.1%(P=0.000)。A、B组手术病理分期多为I期(分别为73.5%、63.6%),其所占比例均明显高于C组的31.4%(P=0.000);而C组多为Ⅲ期(47.7%),其所占比例明显高于A组的23.5%和B组的15.2%(P=0.001)。A、B、C组高分化(分别为11.8%、6.1%、10.5%)、中~低分化(分别为88.2%、93.9%、89.5%)所占比例分别比较,差异均无统计学意义(P=0.602)。A、B、C组雌激素受体(ER)阳性率分别为22.2%(6/27)、31.6%(6/19)、43.9%(136/310),3组间比较,差异有统计学意义(P=0.018);A、B、C组孕激素受体(PR)阳性率分别为22.2%(6/27)、15.8%(3/19)、35.5%(110/310),3组间比较,差异无统计学意义(P=0.082)。?
Objective To investigate clinicopathological features of endometriosis-associated epithelial ovarian carcinoma. Methods Retrospective follow-up study, clinicopathological data from patients with ovarian epithelial carcinoma were retrieved, analyzed and compared. Among the 727 cases, 34 were found to originate from endometriosis (group A ), 33 were found to have co-existing ovarian endometriosis (group B), and the remaining 660 had no ovarian endometriosis at all (group C). Result Seven hundred and twenty-seven epithelial ovarian carcinoma patients were identified and their clinicopathological data retrieved. Sixty-seven (9. 2% ) of these cases were found to have coexisting endometriosis. The frequency of malignant tumors arising from ovarian endometriosis in this case series was estimated to be 0. 87% (34/3890) . The mean (standard deviation) age in groups A, B, and C were(47. 2 ± 1.3), (47. 8±1.2), (51.2 ± 0. 4) years, respectively, with patients in group C being significantly older ( P = 0. 013 ). Patients with coexisting ovarian endometriosis were mostly diagnosed at stage Ⅰ ( P = 0. 000) and having subtype of clear-cell (P = 0. 000), while other patients were mostly diagnosed at stage Ⅲ (P = 0. 001 ) , and having subtype of serous carcinoma (P =0. 000). The estrogen receptor (ER) positivity was significantly lower in groups A and B than that in group C (22. 2% , 31.6% vs 43.9% ; P =0. 018), but the difference in positivity of progestogen receptor among the three groups did not reach statistical significance (22. 2% , 15.8% vs 35.5% ; P = 0. 082). While the five-year overall survival rate for all patients was 55.6% , significant difference in overall survival among the three groups was found 78.9%, 92. 8%, 51.9% , respectively, for groups A, B and C (P = 0.000) . Conclusion Patients of endometriosis-associated epithelial ovarian carcinoma, especially patients with tumors arising from endometriosis, were found to be younger, having a