Хирургия и онкология. 2020; 10: 54-59
Особенности метастазирования и рецидивирования у больных со стромально-клеточными опухолями яичников
https://doi.org/10.17650/2686-9594-2020-10-3-4-54-59Аннотация
Цель исследования – ретроспективный анализ связи стадии заболевания у пациенток со стромально-клеточными опухолями яичников (СКОЯ) с частотой рецидивирования и развития метастазов в лимфатических узлах.
Материалы и методы. Обследовано 473 пациентки с диагнозом СКОЯ различного гистологического типа, проведена оценка особенностей метастазирования и рецидивирования СКОЯ, а также отдаленных результатов лечения.
Результаты. Наиболее высокая частота рецидивов СКОЯ (>80 %) наблюдается при II, III и IV стадиях. Наиболее высокая частота развития метастазов в лимфатических узлах отмечалась у больных со СКОЯ III–IV стадии (50 %), однако более чем в 40 % случаев метастазы в лимфатических узлах развивались у пациенток с IА, IВ, IС стадиями СКОЯ. Остальные 10 % приходились на II стадию заболевания. У пациенток со СКОЯ I стадии, которым не проводилась лимфодиссекция, в 21 % наблюдений развивались метастазы в лимфатических узлах.
Выводы. Высокая частота метастазирования в лимфатические узлы при СКОЯ является фактором риска, изучение которого необходимо для выработки оптимальной хирургической тактики лечения.
Список литературы
1. Бейшембаев А.М. Клинико-морфологические особенности гранулезоклеточных опухолей яичников взрослого типа. Здравоохранение Кыргызстана 2018;(3):22–5. DOI: 10.17749/2313-7347.2019.13.4.289-296.
2. Состояние онкологической помощи населению России в 2018 году. Под ред. А.Д. Капринa, В.В. Старинского, Г.В. Петровой. М., 2019. 231 c.
3. Miura M., Suzuki S., Shibata K. et al. Estrogen producing ovarian fibrosarcoma: A case report. Nagoya J Med Sci 2019;81(1):171–6. DOI: 10.18999/nagjms.81.1.171.
4. Козаченко В.П. Опухоли стромы полового тяжа. Онкогинекология 2015;(4):41–7.
5. Вu Bois A. Role of surgical outcome as prognostic factor in advanced epithelial ovarian cancer: a combined exploratory analysis of 3 prospectively randomized phase 3 multicenter trials: by the Arbeitsgemeinschaft Gynaekologische Onkologie Studiengruppe Ovarialkarzinom (AGO-OVAR) and the Groupe d’Investigateurs Nationaux Pour les Etudes des Cancers de l’Ovaire (GINECO). Cancer 2009;115:1234–44. DOI: 10.1002/cncr.24149.
6. Peiretti M., Zanagnolo V., Aletti G.D. et al. Role of maximal primary cytoreductive surgery in patients with advanced epithelial ovarian and tubal cancer: Surgical and oncological outcomes. Single institution experience. Gynecol Oncol 2010;119(2):259–64. DOI: 10.1016/j.ygyno.2010.07.032.
7. Chang S.J., Bristow R.E. Evolution of surgical treatment paradigms for advanced-stage ovarian cancer: redefining “optimal” residual disease. Gynecol Oncol 2012;125(2):483–92. DOI: 10.1016/j.ygyno.2012.02.024.
8. Wimberger P., Wehling M., Lehmann N. et al. Influence of residual tumor on out-come in ovarian cancer patients with FIGO stage IV disease: an exploratory analysis of the AGO-OVAR (Arbeitsgemeinschaft Gynaekologische Onkologie Ovarian Cancer Study Group). Ann Surg Oncol 2010;17(6):1642–8. DOI: 10.1245/s10434-010-0964-9.
9. NCCN guidelines panel. Epithelial Ovarian Cancer. Version 1.2020. P. OV1. Available at: https://www.nccn.org/professionals/physician_gls/f_guidelines.asp#ovarian.
10. Harter P., Gnauert K., Hils R. et al. Pattern and clinical predictors of lymph node metastases in epithelial ovarian cancer. Int J Gynecol Cancer 2007;17(6):1238–44. DOI: 10.1111/j.1525-1438.2007.00931.x.
11. May K., Bryant A., Dickinson H.O. et al. Lymphadenectomy for the management of endometrial cancer. Cochrane Database Syst Rev 2010;(1):CD007585. DOI: 10.1002/14651858.CD007585.pub2.
12. Morice P., Joulie F., Camatte S. et al. Lymph node involvement in epithelial ovarian cancer: analysis of 276 pelvic and paraaortic lymphadenectomies and surgical implications. J Am Coll Surg 2003;197(2):198–205. DOI: 10.1016/S1072-7515(03)00234-5.
13. Kang M., Lee K.B., Park Y.H., Cho H.Y. First reported case of intrahepatic cholangiocarcinoma metastasis to thecoma. J Obstet Gynaecol 2019;39(3):429–31. DOI: 10.1080/01443615.2018.1504901.
14. Boussios S., Zarkavelis G., Seraj E. et al. Non-epithelial Ovarian Cancer: Elucidating Uncommon Gynaecological Malignancies. Anticancer Res 2016;36(10):5031–42. DOI: 10.21873/anticanres.11072.
15. Ghosh A., Ghartimagar D., Thapa S. et al. Ovarian tumors: pattern of histomorphological types – a 10 years study in a tertiary referral center and review of literature. Kathmandu Univ Med J (KUMJ) 2016;14(54):153–8.
16. Паяниди Ю.Г., Жорданиа К.И., Козаченко В.П. и др. Реабилитация больных с ятрогенной преждевременной недостаточностью яичников. Онкогинекология 2018;1(25):67–76.
Surgery and Oncology. 2020; 10: 54-59
Features of metastasis and recurrence in patients with stromal cell ovarian tumors
https://doi.org/10.17650/2686-9594-2020-10-3-4-54-59Abstract
Objective: a retrospective analysis of association of the tumor stage of stromal cell ovarian tumors with the frequency of recurrence and development of metastases in lymph nodes.
Materials and methods. 473 patients with stromal cell ovarian tumors with various histological types were examined, and long-term treatment results were evaluated.
Results. The highest recurrence rate (more than 80 %) was observed in stages II, III and IV. The frequency of development of metastases in the lymph nodes was highest in patients with stromal cell ovarian tumors of III–IV stages (50 %); however, in more than 40 % of cases of metastases in the lymph nodes was developed in patients with stromal cell ovarian tumors of IА, IВ, IС stages. The remaining 10 % of cases were in patients with stromal cell ovarian tumors of II stage. In patients with I stage without lymphadenectomy, metastases in the lymph nodes was developed in 21 % cases.
Conclusions. The high frequency of lymph node metastasis in patients with stromal cell ovarian tumors is a risk factor, which had to be evaluated to develop surgical treatment tactics.
References
1. Beishembaev A.M. Kliniko-morfologicheskie osobennosti granulezokletochnykh opukholei yaichnikov vzroslogo tipa. Zdravookhranenie Kyrgyzstana 2018;(3):22–5. DOI: 10.17749/2313-7347.2019.13.4.289-296.
2. Sostoyanie onkologicheskoi pomoshchi naseleniyu Rossii v 2018 godu. Pod red. A.D. Kaprina, V.V. Starinskogo, G.V. Petrovoi. M., 2019. 231 c.
3. Miura M., Suzuki S., Shibata K. et al. Estrogen producing ovarian fibrosarcoma: A case report. Nagoya J Med Sci 2019;81(1):171–6. DOI: 10.18999/nagjms.81.1.171.
4. Kozachenko V.P. Opukholi stromy polovogo tyazha. Onkoginekologiya 2015;(4):41–7.
5. Vu Bois A. Role of surgical outcome as prognostic factor in advanced epithelial ovarian cancer: a combined exploratory analysis of 3 prospectively randomized phase 3 multicenter trials: by the Arbeitsgemeinschaft Gynaekologische Onkologie Studiengruppe Ovarialkarzinom (AGO-OVAR) and the Groupe d’Investigateurs Nationaux Pour les Etudes des Cancers de l’Ovaire (GINECO). Cancer 2009;115:1234–44. DOI: 10.1002/cncr.24149.
6. Peiretti M., Zanagnolo V., Aletti G.D. et al. Role of maximal primary cytoreductive surgery in patients with advanced epithelial ovarian and tubal cancer: Surgical and oncological outcomes. Single institution experience. Gynecol Oncol 2010;119(2):259–64. DOI: 10.1016/j.ygyno.2010.07.032.
7. Chang S.J., Bristow R.E. Evolution of surgical treatment paradigms for advanced-stage ovarian cancer: redefining “optimal” residual disease. Gynecol Oncol 2012;125(2):483–92. DOI: 10.1016/j.ygyno.2012.02.024.
8. Wimberger P., Wehling M., Lehmann N. et al. Influence of residual tumor on out-come in ovarian cancer patients with FIGO stage IV disease: an exploratory analysis of the AGO-OVAR (Arbeitsgemeinschaft Gynaekologische Onkologie Ovarian Cancer Study Group). Ann Surg Oncol 2010;17(6):1642–8. DOI: 10.1245/s10434-010-0964-9.
9. NCCN guidelines panel. Epithelial Ovarian Cancer. Version 1.2020. P. OV1. Available at: https://www.nccn.org/professionals/physician_gls/f_guidelines.asp#ovarian.
10. Harter P., Gnauert K., Hils R. et al. Pattern and clinical predictors of lymph node metastases in epithelial ovarian cancer. Int J Gynecol Cancer 2007;17(6):1238–44. DOI: 10.1111/j.1525-1438.2007.00931.x.
11. May K., Bryant A., Dickinson H.O. et al. Lymphadenectomy for the management of endometrial cancer. Cochrane Database Syst Rev 2010;(1):CD007585. DOI: 10.1002/14651858.CD007585.pub2.
12. Morice P., Joulie F., Camatte S. et al. Lymph node involvement in epithelial ovarian cancer: analysis of 276 pelvic and paraaortic lymphadenectomies and surgical implications. J Am Coll Surg 2003;197(2):198–205. DOI: 10.1016/S1072-7515(03)00234-5.
13. Kang M., Lee K.B., Park Y.H., Cho H.Y. First reported case of intrahepatic cholangiocarcinoma metastasis to thecoma. J Obstet Gynaecol 2019;39(3):429–31. DOI: 10.1080/01443615.2018.1504901.
14. Boussios S., Zarkavelis G., Seraj E. et al. Non-epithelial Ovarian Cancer: Elucidating Uncommon Gynaecological Malignancies. Anticancer Res 2016;36(10):5031–42. DOI: 10.21873/anticanres.11072.
15. Ghosh A., Ghartimagar D., Thapa S. et al. Ovarian tumors: pattern of histomorphological types – a 10 years study in a tertiary referral center and review of literature. Kathmandu Univ Med J (KUMJ) 2016;14(54):153–8.
16. Payanidi Yu.G., Zhordania K.I., Kozachenko V.P. i dr. Reabilitatsiya bol'nykh s yatrogennoi prezhdevremennoi nedostatochnost'yu yaichnikov. Onkoginekologiya 2018;1(25):67–76.
