胃肠恶性肿瘤合并卵巢转移的预后因素及随访策略分析  

Analysis of prognosis factors and follow-up strategy of ovary metastasis derived from gastric and colorectal cancer

作　　者：刘小野[1] 杨小宝 王鈢 尹杰[1] 张军[1] 姚宏伟[1] 杨盈赤[1] 张忠涛[1] Liu Xiaoye;Yang Xiaobao;Wang Xi;Yin Jie;Zhang Jun;Yao Hongwei;Yang Yingchi;Zhang Zhongtao(Department of General Surgery,Beijing Friendship Hospital,Capital Medical University,Beijing 100050,China;National Clinical Research Center for Digestive Diseases,Beijing 100050,China)

机构地区：[1]首都医科大学附属北京友谊医院普通外科,国家消化系统疾病临床医学研究中心,100050

出　　处：《国际外科学杂志》2021年第8期560-564,共5页International Journal of Surgery

基　　金：国家科技支撑计划课题(2015BAI13B09);国家重点研发计划资助(2017YFC0110904)。

摘　　要：目的:分析胃及结直肠来源库肯勃(Krukenberg)瘤的相关预后因素,并根据预后因素指导综合治疗;寻找在胃癌和结直肠癌术后随访复查过程中,监测卵巢复发转移的客观敏感指标,为早期诊断提供依据。方法:回顾性分析2007年6月—2020年2月首都医科大学附属北京友谊医院收治的75例患Krukenberg瘤患者的临床资料,利用Log-rank法和COX回归单因素和多因素分析,寻找独立预后因素;并且在异时性转移患者的随访中,应用Wilcoxon秩和检验比较卵巢影像学及肿瘤标志物的动态变化,寻找敏感性更佳的变化指标。结果:单因素分析提示,CA19-9≥123.5 U/mL(P=0.001)、CA12-5≥37.9 U/mL(P=0.018)、胃来源krukenberg瘤(P=0.037),卵巢外其他器官转移(P=0.014)以及未行减瘤手术(CRS)(P<0.001)是预后不良因素,其中减瘤手术可明显改善预后,且即使存在肉眼可见残留灶,其总体生存期仍明显长于未行减瘤手术者(P=0.004)。多因素分析结果显示CA19-9升高(P=0.010)以及减瘤手术(P=0.001)是Krukenberg瘤患者的独立预后因素;在术后随访过程中,超声及CT的影像学变化对发生卵巢转移的敏感性更佳(P=0.006)。结论:接受减瘤手术可明显延长患者的总生存期,同时性转移患者不应放弃手术机会,异时性转移的患者也应行转移灶切除,且即使存在肉眼可见残留灶,患者仍可从中获益;在胃癌和结直肠癌术后随访过程中,应重视卵巢超声及CT影像学变化,有助于早期发现卵巢转移灶。Objective:To analyze the prognostic factors of Krukenberg tumors derived from the gastric cancer and colorectal cancer,so as to guide comprehensive treatment;looking for objective and sensitive indicators of ovarian metastasis during the follow-up after the surgery for gastric and colorectal cancer,which provides a basis for early diagnosis.Methods:Retrospectively analyzed the clinical data of 75 patients diagnosed with Krukenberg tumor admitted to Beijing Friendship Hospital,Capital Medical University from June 2007 to February 2020.Log-rank method and COX regression analysis were used to find independent prognostic factors.Wilcoxon rank sum test was used to compare the dynamic changes of ovarian imaging and tumor markers and to find the more sensitive indicators in the follow-up of patients with metachronous metastasis.Results:In the 75 cases,the univariate analysis suggested that CA19-9≥123.5 U/mL(P=0.001),CA12-5≥37.9 U/mL(P=0.018),Krukenberg tumor of stomach origin(P=0.037),extra-ovary metastasis(P=0.014),and without cytoreductive surgery(CRS)(P<0.001)were poor prognostic factors.Among them,cytoreductive surgery could significantly improve the prognosis,even if with visible residual lesions,the overall survival was still significantly longer than those who have not undergone cytoreductive surgery(P=0.004).Multivariate analysis results showed that CA19-9 and cytoreductive surgery(P=0.001)were independent prognostic factors for patients with Krukenberg tumor;during the postoperative follow-up,ultrasound and CT imaging changes were more sensitive to ovarian metastasis(P=0.006).Conclusions:CRS can prolong significantly the overall survival(OS)of patients with krukenberg tumor.Patients with simultaneous metastases should not give up the opportunity for surgery,and patients with metachronous metastases should also receive ovary resection procedure,even if with visible residual lesions,the patients can still benefit from the procedure.In the follow-up for gastric and colorectal cancer,attention should be paid to

关 键 词：KRUKENBERG瘤 卵巢 胃肿瘤 结直肠肿瘤 减瘤手术 

分 类 号：R735[医药卫生—肿瘤]