早期卵巢癌患者的微创手术与包膜破裂的风险

Minimally Invasive Surgery and Risk of Capsule Rupture for WomenWith Early Stage Ovarian Cancer.
早期卵巢癌患者的微创手术与包膜破裂的风险

Matsuo K, et al. JAMA Oncol. 2020;6（7）:11101113. doi:10.1001/jamaoncol.2020.1702.

ABSTRACT
Ovarian cancer remains the deadliestgynecologic malignant Neoplasm in the United States. Salpingo oophorectomy withthe intact removal of the ovary and fallopian tube is the standard approach forsuspected ovarian malignant neoplasm apparently confined to the ovary. Surgeryfor early stage ovarian cancer has historically been performed via laparotomy.However, in recent years, more women with ovarian cysts and masses have beentreated with minimally invasive surgery（MIS）, including laparoscopy. To date,there are limited data to support the safety and oncologic outcomes of MIS forearly stage ovarian cancer. The objective of this study was to examine theassociation between MIS use, capsule rupture, and survival of women with stageI epithelial ovarian cancer.
摘要
卵巢癌仍然是美国死亡率很高的妇科恶性肿瘤。卵巢和输卵管完整切除的输卵管-卵巢切除术是明显局限于卵巢的疑似卵巢恶性肿瘤的标准治疗。早期卵巢癌手术历来通过剖腹手术进行。然而，近年来，越来越多的卵巢囊肿和肿块患者接受微创手术（MIS），包括腹腔镜检
查。到目前为止，支持 MIS治疗早期卵巢癌的安全性和肿瘤预后的数据有限。这项研究旨在探讨 MIS、包膜破裂与Ⅰ期上皮性卵巢癌患者生存的相关性。

METHODS
This is an observational study of womenwith stage I epithelial ovarian cancer who underwent surgery from 2010 to 2015and were registered in the National Cancer Database. All women underwentadnexectomy. The study used deidentified data and was deemed exempt by theColumbia University Institutional Review Board.
方法
这是一项观察性研究，研究对象为2010年至2015年在国家癌症数据库登记的Ⅰ期上皮性卵巢癌患者。所有女性均接受了附件切除术。这项研究使用去识别化的数据，并被哥伦比亚大学伦理审查委员会认定为免责。

RESULTS
Among 8850 women（mean [SD] age, 55.6 [13.7]years） with stage I ovarian cancer, 2600 women（29.4%） underwent MIS. Use ofMIS increased from19.8%（263 of 1330） in 2010 to 34.9%（554 of 1589） in 2015（1.8--fold increase; P < .001）. In a multivariable model, more recent yearof surgery and serous histologic characteristics were associated with use ofMIS. The median follow--up was 39.4 months, and the 4--year overall survivalrate decreased by 5.0% between 2010（overall survival, 91.0%） and2015（overallsurvival,86.0%）. Women with ruptured tumors had lower overall survival comparedwith those with nonruptured tumors in univariable analysis: 4--year rates,86.8% for open surgery and ruptured tumors, 88.9% for MIS and ruptured tumors,90.5% for open surgery and nonruptured tumors, and 91.5% for MIS andnonruptured tumors（log--rank test, P = .001）
结果
8850例Ⅰ期卵巢癌患者（平均年龄[SD]为55.6[13.7]岁）中，2600例（29.4%）患者接受了MIS的使用率从2010年的 19.8%（263/1330）增加至2015年的34.9%（554/1589）（增长1.8倍；P<0.001）。在一个多变量模型中，最近一年的手术和血清组织学特征与MIS的使用相关。中位随访时间为39.4个月，4年总生存率在2010年（总生存率91.0%）和2015年（总生存率86.0%）间下降了5.0%。在单变量分析中，与肿瘤未破裂的患者相比，肿瘤破裂患者的总生存率较低：接受开放式手术且肿瘤破裂患者的4年生存率为率为86.8%，接受MIS且肿瘤破裂患者的4年生存率为88.9%，接受开放式手术且肿瘤未破裂患者的4年生存率为90.5%，接受MIS且肿瘤未破裂患者的4年生存率为91.5%（对数秩检验，P=0.001）。

DISCUSSION
There has been a significant increase inthe use of MIS among women with early--stage ovarian cancer in the UnitedStates. In the present study, MIS was associated with an increased risk ofcapsule rupture, which was associated with increased mortality. An increasedrate of capsular rupture among women with benign adnexal cysts undergoing MIShas been previously reported, but this association has received little attentionfor women with ovarian cancer.
讨论
在美国，早期卵巢癌患者中接受MIS的人数显著增加。目前研究中，MIS与包膜破裂的风险增加相关，从而与死亡率增加相关。既往报道显示，良性附件囊肿女性接受MIS手术后膜破裂率增加，但是这种相关性在卵巢癌女性中却很少受到关注。