早期卵巢上皮性癌和交界性肿瘤保留生育功能相关问题

摘要/Abstract

摘要：

文章分别对早期卵巢上皮性癌（EOC）及交界性卵巢癌（BOT）年轻患者要求保留生育功能治疗的术式、选择病例标准、术中注意事项、术后相关问题及妊娠结局进行讨论。在对EOC及BOT患者进行保留生育功能手术（FSS）治疗前应与患者充分讨论和交流，使患者充分理解此种术式治疗后的生育潜在可能性和安全性。手术应由有经验的妇瘤医师施行，保证分期手术的准确性；术后多学科（妇科肿瘤医师、生殖医学专家、产科医师）会诊，共同治疗、随访，是获得妊娠良好结局和患者安全的保证。

关键词: 卵巢癌, 交界性肿瘤, 保留生育功能

Abstract:

Abstract：In this paper we’ll discuss the fertility-sparing surgery in EOC and BOT separatelly. The surgical procedures of FSS, the carefully selected patients, the other important factors which should be paid attention to during staging surgery or postoperation care and the outcome of pregnancy of FSS are discussed. It is emphasized that the discussion about this conservative treatment with patients should be fully, before surgery, patients have to understand the conservative surgery treatment for EOC early stage, the potential possibility of pregnancy and the safety. The FSS should be performed by a gynecologic oncologist in order to get a staging exactly.Counseling with gynecologic oncologist, reproductive experts, and obstetrician, multi disciplinary treatment and follow up are important factors to get good outcome of FSS and safety for patient.

Key words: ovarian cancer, borderline or low malignant potential tumor;fertility-sparing

中图分类号:

R711.74

彭芝兰. 早期卵巢上皮性癌和交界性肿瘤保留生育功能相关问题[J]. 中国实用妇科与产科杂志.

参考文献



[1］ Leblanc E, Narducci F, Ferron G, et al. Indications and teaching of fertility preservation in the surgical management of gynecologic malignancies: European perspective［J］. Gynecol Oncol, 2009,114: 532-536.

[2］ Rodriguez-Wallberg KA, Oktay K.Options on fertility preservation in female cancer patients［J］. Cancer Treat Rev,2012,38:354-361.

[3］ Fleming GF, Ronnett BM, Seidman J. Epithelial ovarian cancer［M］// Barakat RR, Markman M, Randall ME, eds. Principles and practice of gynecologic oncology. 5th ed. Philadelphia: Lippincott Williams & Wikins,2009:763-836.

[4］ Schilder JM, Thompson AM, DePriest PD, et al. Outcome of reproductive age women with stage IA of IC invasive epithelial ovarian cancer treated with fertility-sparing therapy［J］. Gynecol Oncol, 2002, 87:1-7.

[5］ Trimbos JB, van der Burg ME. Adjuvant chemotherapy in patients operated on for early ovarian carcinoma［J］. Ned Tijdschr Geneeskd, 2004,148(18):874-878.

[6］ Lu KH, Skates S, Bevers TB, et al. A prospective U.S. ovarian cancer screening study using the risk of ovarian cancer algorithm (ROCA)［J］. J Clin Oncol, 2010,28(Suppl 15): 2003. 

[7］ Jacob F, Meier M, Caduff R, et al. No benefit from combining HE4 and CA125 as ovarian tumor markers in a clinical setting［J］. Gynecol Oncol, 2011,121:487-491.

[8］ Moore RG, Miller MC, Disilvestro P, et al. Evaluation of the diagnostic accuracy of the risk of ovarian malignancy algorithm in women with a pelvic mass［J］. Obstet Gynecol, 2011,118:208-288.

[9］ Du Bois A, Quinn M, Thigpen T, et al. 2004 consensus statements on the management of ovarian cancer: final document of the 3rd International Gynecologic Cancer Intergroup Ovarian Cancer Consensus Conference (GCIG OCCC 2004) ［J］. Ann Oncol, 2005,16 (Suppl 8 ):viii7-viii12.

[10］ Earle CC, Schrag D, Neville BA, et al. Effect of surgeon specialty on processes of care and outcomes for ovarian cancer patients［J］. J Natl Cancer Inst, 2006,98:172-180.

[11］ Giede KC, Kieser K, Dodge J, et al. Who should operate on patients with ovarian cancer:an evidence-based review ［J］.Gunecol Oncol, 2005,99:447-461.

[12］ Martinez A, Poilblanc M, Ferron G, et al. Fertility-preserving surgical procedures, techniques［J］. Best Pract Res Clin Obstet Gynaecol, 2012，26:407-424.

[13］ Jun Hu, Li-rong Zhu, Zhi-qing Liang, et al. Clinical outcomes of fertility-sparing treatments in young patients with epithelial ovarian carcinoma［J］. Biomed Biotechnol, 2011, 12(10):787-795.

[14］ Park J, Kim D, Suh D, et al. Outcomes of fertility-sparing surgery for invasive epithelial ovarian cancer: oncologic safety and reproductive outcomes［J］. Gynecol Oncol, 2008,110: 345-353.

[15］ Stier EA, Barakat RR, Curtin JP, et al. Laparotomy to complete staging of presumed early ovarian cancer［J］. Obstet Gynecol, 1996,87:737-740. 

[16］ Wright JD, Shah M, Mathew L, et al. Fertility preservation in young women with epithelial ovarian cancer［J］. Cancer, 2009,115:4118-4126.

[17］ Bines J, Oleske DM, Cobleigh MA. Ovarian function in premenopausal women treated with adjuvant chemotherapy for breast cancer［J］. J Clin Oncol, 1996,14:1718-1729.

[18］ Meirow D, Levron J, Eldar-Geva T, et al. Pregnancy after transplantation of cryopreserved ovarian tissue in a patient with ovarian failure after chemotherapy［J］. N Engl J Med,2005,353(3):318-321.

[19］ Minton SE, Munster PN. Chemotherapy-induced amenorrhea and fertility in women undergoing adjuvant treatment for breast cancer［J］. Cancer Control, 2002,9:466-472.

[20］ Recchia F, Saggio G, Amiconi G, et al. Gonadotropin-releasing hormone analogues added to adjuvant chemotherapy protect ovarian function and improve clinical outcomes in young women with early breast carcinoma［J］. Cancer, 2006,106:514-523.

[21］ Morice P, Leblanc E, Rey A, et al. Conservative treatment in epithelial ovarian cancer: results of a multicentre study of the GCCLCC (Groupe des Chirurgiens de Centre de Lutte Contre le Cancer) and SFOG (Socie′te′ Franc aise d' Oncologie Gyne′cologique) ［J］. Hum Reprod, 2005,20（5）:1379-1385. 

[22］ Ramez N, Eskander, Leslie M, et al. Fertility preserving options in patients with gynecologic malignancies［J］. Am J Obstet Gynecol, 2011, 103:110-117.

[23］ Satoh T, Hatae M, Watanabe Y, et al. Outcomes of fertility-sparing surgery for stage I epithelial ovarian cancer: a proposal for patient selection［J］. J Clin Oncol, 2010, 28:1727-1732.

[24］ Lalwani N, Anampady KPS, Vikram R, et al. Current update on borderline ovarian neoplasms［J］. AJR, 2010,194: (2):330-336.

[25］彭芝兰.复发性卵巢上皮交界性肿瘤的诊治［J］.中国实用妇科与产科杂志,2012,28(5): 340-344.

[26］ Jeong-Yeol Park, Dae-Yeon Kim, Jong-Hyeok Kim, et al. Surgical management of borderline ovarian tumors: The role of fertility-sparing surgery［J］. Gynecol Oncol, 2009,113:75-82.

[27］ Joo-Hyun Nam. Borderline ovarian tumors and fertility［J］.Current Opinion in Obstetrics and Gynecology,2010,22:227-234.

[28］ Lenhard MS, Mitterer S, Kümper C, et al. Long-term follow-up after ovarian borderline tumor: Relapse and survival in a large patient cohort［J］. Eur J Obstet Gynecol Reprod Biol, 2009,145(2):189-194. 

[29］ Uzan C,Kane A,Rey A, et al. Outcomes after conservative treatment of advancedstage serous borderline tumors of the ovary［J］. Ann Oncol, 2010,21:55-60.

[30］ Morris RT, Gershenson DM, Silva EG,et al. Outcome and reproductive function after conservative surgery for borderline ovarian tumors［J］. Obstet Gynecol,2000,95(4):541-547.

[31］ Fotopoulou C, Schumacher G, Joerg C, et al. Systematic evaluation of the intraoperative tumor pattern in patients with borderline tumor of the ovary［J］. Int J Gynecol Cancer, 2009, 19(9):1550-1555.

[32］ Ren Jie, Peng Zhilan. A clinicopathologic Multivariate analysisi affecting recurrence of borderline ovarian tumors［J］. Gynecol Oncol, 2008,110:162-167.

[33］ Laurent I, Uzan C, Gouy S, et al.Results after conservative treatment of serous borderline tumors of the ovary with a micropapillary pattern［J］. Ann Surg Oncol,2008,15(12):3561-3566. 

[34］ Laurent I, Uzan C, Gouy S, et al. Results after conservative treatment of serous borderline tumours of the ovary with stromal microinvasion but without micropapillary pattern［J］. BJOG,2009 ,116(6):860-862. 

[1]	李晶, 吴妙芳, 林仲秋. 《FIGO 2021妇癌报告》——卵巢癌、输卵管癌、腹膜癌诊治指南解读[J]. 中国实用妇科与产科杂志, 2022, 38(3): 301-309.
[2]	卢淮武, 吴斌, 许妙纯, 霍楚莹, 林仲秋. 《2022 NCCN卵巢癌包括输卵管癌及原发性腹膜癌临床实践指南（第1版）》解读[J]. 中国实用妇科与产科杂志, 2022, 38(3): 310-318.
[3]	马丁. 卵巢癌研究进展与规范化治疗[J]. 中国实用妇科与产科杂志, 2021, 37(6): 601-604.
[4]	高庆蕾. 卵巢癌与基因检测的规范化[J]. 中国实用妇科与产科杂志, 2021, 37(6): 605-609.
[5]	黄鹤，冯艳玲，刘继红. 卵巢癌的初始与间歇性肿瘤细胞减灭术相关问题[J]. 中国实用妇科与产科杂志, 2021, 37(6): 609-613.
[6]	窦莎，李艺，崔恒. 初诊上皮性卵巢癌的一线化疗[J]. 中国实用妇科与产科杂志, 2021, 37(6): 613-616.
[7]	陈雨莲，史庭燕，臧荣余. 铂敏感复发卵巢癌手术相关问题与规范化诊疗[J]. 中国实用妇科与产科杂志, 2021, 37(6): 616-620.
[8]	邓黎，梁志清. 微创手术在卵巢癌治疗中的应用与争议[J]. 中国实用妇科与产科杂志, 2021, 37(6): 620-623.
[9]	袁增，宋坤，孔北华. 遗传性卵巢癌预防性附件切除术的相关问题与争议[J]. 中国实用妇科与产科杂志, 2021, 37(6): 623-627.
[10]	孟元光，叶明侠. 卵巢癌肿瘤细胞减灭术的并发症及防治[J]. 中国实用妇科与产科杂志, 2021, 37(6): 627-630.
[11]	蒋芳，向阳. 卵巢癌免疫治疗的现状与进展[J]. 中国实用妇科与产科杂志, 2021, 37(6): 630-634.
[12]	王登凤，张国楠. 卵巢癌靶向治疗的规范化[J]. 中国实用妇科与产科杂志, 2021, 37(6): 634-639.
[13]	张师前，李小平. 晚期上皮性卵巢癌新辅助化疗指征的快速指南（2021年版）[J]. 中国实用妇科与产科杂志, 2021, 37(4): 444-448.
[14]	林仲秋. 《2021 NCCN卵巢癌包括输卵管癌及原发性腹膜癌临床实践指南（第1版）》解读[J]. 中国实用妇科与产科杂志, 2021, 37(4): 457-466.
[15]	卢淮武，霍楚莹. 《2020 NCCN卵巢癌包括输卵管癌及原发性腹膜癌临床实践指南（第1版）》解读[J]. 中国实用妇科与产科杂志, 2020, 36(4): 340-348.