目的:基于单中心的数据探讨卵巢子宫内膜样囊肿(endometriotic cyst,EC)起源及非EC起源的卵巢透明细胞癌(ovarian clear cell carcinoma,OCCC)的临床病理特征及预后.方法:回顾性分析2007年11月至2015年2月于复旦大学附属妇产科医院手术并经病理确诊的126例OCCC患者的临床资料.首次根据是否起源于 EC将患者分为EC组和non-EC组,进行临床病理特征和预后分析的比较.结果:OCCC患者中46例(36.5%)起源于EC(EC组),80例(63.5%)非起源于EC(non-EC组).与non-EC组相比,EC组确诊时的平均年龄更小[(50.1 ± 5.6)岁 vs(53.3 ± 8.6)岁,P=0.011],产次更少(100.0%vs 87.5%,P=0.012),更倾向于累及单侧卵巢(95.7% vs 82.5%,P=0.033),术前血CA125≤200 U/mL的比例更高(94.9%vs 60.8%,P<0.001),国际妇产科联盟(FIGO)分期更早(95.7% vs 58.8%,P<0.001),满意瘤体减灭率更高(100.0% vs 91.3%,P=0.039),化疗敏感率也更高(93.3% vs 71.2%,P=0.04).Kaplan-Meier生存曲线显示:EC组患者疾病无进展生存期(PFS)和总生存期(OS)均显著优于non-EC组.单因素及多因素分析表明:EC起源不是OCCC患者PFS和OS的独立预测因素,FIGO分期和化疗敏感性是预测 PFS的独立因素,化疗敏感性是预测OS的独立因素.结论:与非EC起源患者相比, EC起源OCCC患者具有更多预后有利因素,但EC起源不是患者生存预后的独立影响因素.%Objective:To analyze and compare the clinical pathological features and prognosis of ovarian clear cell carcinoma(OCCC)deriving or not deriving from endometriotic cyst(EC).Methods:Clinical data of 126 patients who were pathologically diagnosed with OCCC from November 2007 to February 2015 were retrospectively analyzed.The patients were divided into EC group and non-EC group according to the cell origin.The clinical,pathological and prognostic data were compared between groups.Results:Among 126 OCCC,46(36.5%)originated from EC(EC group)and 80(63.5%)did not originate from EC(non-EC group).Compared with non-EC group,the patients in EC group were younger at the time of diagnosis([50.1 ± 5.6]years old vs[53.3 ± 8.6]years old,P=0.011)and less likely to be multiparous(100.0% vs 87.5%, P=0.012),with more unilateral ovarian involvement(95.7% vs 82.5%,P= 0.033)and higher ratio of preoperative CA125 ≤200 U/mL(94.9% vs 60.8%,P<0.001).The patients in EC group were more likely to be at early FIGO stage (95.7% vs 58.8%,P<0.001)with higher cytoreduction(100.0% vs 91.3%,P=0.039)and chemosensitivity rate(93.3%vs 71.2%,P= 0.04).EC group showed better progression-free survival(PFS)and overall survival(OS)in Kaplan-Meier survival curve compared with non-EC group.Univariate and multivariate analysis showed that EC origin was not an independent predictor of survival outcome,while the tumor stage and chemosensitivity were the independent prognostic factors for PFS and the chemosensitivity was the only independent prognostic factor for OS.Conclusions:OCCC deriving from EC has more favorable factors for survival outcome compared with OCCC not deriving from EC,while EC origin is not an independent prognostic factor.
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