卵巢交界性腫瘤診治進(jìn)展

武漢大學(xué)人民醫(yī)院婦I科張蔚卵巢交界性腫瘤診治進(jìn)展卵巢腫瘤概述1卵巢交界性腫瘤概述2卵巢交界性腫瘤診斷3卵巢交界性腫瘤治療及預(yù)后4總結(jié)5目錄1.卵巢腫瘤現(xiàn)狀一、卵巢腫瘤概述（1）近20年發(fā)病率上升20倍（2）診斷和治療研究進(jìn)展緩慢（3）工業(yè)化發(fā)展+節(jié)制生育----潛在病因（4）卵巢組織復(fù)雜，各種腫瘤均可發(fā)生（5）2/3患者，就診時(shí)已是晚期（6）5年生存率20-30%2.卵巢腫瘤病因一、卵巢腫瘤概述遺傳和家族因素（1）家族聚集性卵巢癌（2）一家數(shù)代均發(fā)?。?）上皮性多見(jiàn)環(huán)境因素（1）工業(yè)發(fā)達(dá)國(guó)家（2）膽固醇含量高內(nèi)分泌因素（1）激素依賴性腫瘤（2）無(wú)生育者發(fā)病多高危因素3.卵巢腫瘤組織學(xué)分類一、卵巢腫瘤概述3.卵巢腫瘤組織學(xué)分類一、卵巢腫瘤概述3.卵巢腫瘤組織學(xué)分類一、卵巢腫瘤概述

malignancy

惡性

benign

交良性界性

1.概述二、卵巢交界性腫瘤特點(diǎn)（1）又稱臨界惡性卵巢腫瘤或低度惡性潛在性癌，約占卵巢腫瘤的10%—15%（2）1929年Taylor最先描述，1973年世界衛(wèi)生組織WHO正式命名為BOTs（3）屬上皮性腫瘤（4）生物學(xué)行為介于良性與惡性之間（5）包含良性增生及惡性無(wú)浸潤(rùn)的腫瘤2.組織學(xué)分類二、卵巢交界性腫瘤特點(diǎn)交界性混和型上皮性腫瘤Brenner交界性腫瘤交界性透明細(xì)胞腫瘤組織學(xué)分類3.臨床特點(diǎn)二、卵巢交界性腫瘤特點(diǎn)4.病理學(xué)特點(diǎn)二、卵巢交界性腫瘤特點(diǎn)（1）不同程度的細(xì)胞增生和核異型（2）與浸潤(rùn)性卵巢癌的區(qū)別是缺乏明顯的間質(zhì)浸潤(rùn)（3）發(fā)病年齡較輕，平均45歲左右（4）診斷時(shí)常處于早期，根據(jù)國(guó)際婦產(chǎn)科協(xié)會(huì)FIGO分期約50%—85%的BOTs處于Ⅰ期（5）即使晚期患者也有令人滿意的預(yù)后，早期患者5年生存率可達(dá)98%，晚期患者也可達(dá)86%—92%5.并發(fā)癥二、卵巢交界性腫瘤特點(diǎn)（1）蒂扭轉(zhuǎn)（2）破裂（3）感染（4）惡變蒂扭轉(zhuǎn)6.臨床分期二、卵巢交界性腫瘤特點(diǎn)6.臨床分期二、卵巢交界性腫瘤特點(diǎn)III期:一側(cè)或雙側(cè)卵巢腫瘤，伴顯微鏡下證實(shí)的盆腔外的腹腔轉(zhuǎn)移和（或）區(qū)域淋巴結(jié)轉(zhuǎn)移。肝表面轉(zhuǎn)移位III期。

IIIa:顯微鏡下證實(shí)的盆腔外的腹腔轉(zhuǎn)移

IIIb:腹腔轉(zhuǎn)移灶直徑≤2cmIIIc:腹腔轉(zhuǎn)移灶直徑>2cm和（或）區(qū)域淋巴結(jié)轉(zhuǎn)移。IV期遠(yuǎn)處轉(zhuǎn)移，除外腹腔轉(zhuǎn)移。（胸水有癌細(xì)胞，肝實(shí)質(zhì)轉(zhuǎn)移）三、卵巢交界性腫瘤診斷[1]VrabieCD,PetrescuA,WallerM,etal.Clinicalfactorsandbiomarkersinovariantumorsdevelopment[J].RomJMorpholEmbryol,2008,49(3):327-338.[2]AyhanA,GuvenS,GuvenES,etal.Isthereacorrelationbetweentumormarkerpanelandtumorsizeandhistopathologyinwellstagedpatientswithborderlineovariantumors?[J].ActaObstetGynecolScand,2007,86(4):484-490.三、卵巢交界性腫瘤診斷[3]VanCalsterB,TimmermanD,BourneT,etal.DiscriminationbetweenbenignandmalignantadnexalmassesbyspecialistultrasoundexaminationversusserumCA-125[J].JNatlCancerInst,2007,99(22):1706-1714.[4]MaheshwariA,GuptaS,KaneS,etal.Accuracyofintraoperativefrozensectioninthediagnosisofovarianneoplasms:experienceatatertiaryoncologycenter[J].WorldJSurgOncol,2006,4:12.[5]TempferCB,PolterauerS,BentzEK,etal.Accuracyofintraoperativefrozensectionanalysisinborderlinetumorsoftheovary:aretrospectiveanalysisof96casesandreviewoftheliterature[J].GynecolOncol,2007,107(2):248-252.1.卵巢交界性腫瘤治療四、卵巢交界性腫瘤治療及預(yù)后[1]VrabieCD,PetrescuA,WallerM,etal.Clinicalfactorsandbiomarkersinovariantumorsdevelopment[J].RomJMorpholEmbryol,2008,49(3):327-338.[2]AyhanA,GuvenS,GuvenES,etal.Isthereacorrelationbetweentumormarkerpanelandtumorsizeandhistopathologyinwellstagedpatientswithborderlineovariantumors?[J].ActaObstetGynecolScand,2007,86(4):484-490.[3]VanCalsterB,TimmermanD,BourneT,etal.DiscriminationbetweenbenignandmalignantadnexalmassesbyspecialistultrasoundexaminationversusserumCA-125[J].JNatlCancerInst,2007,99(22):1706-1714.1.卵巢交界性腫瘤治療四、卵巢交界性腫瘤治療及預(yù)后[4]MaheshwariA,GuptaS,KaneS,etal.Accuracyofintraoperativefrozensectioninthediagnosisofovarianneoplasms:experienceatatertiaryoncologycenter[J].WorldJSurgOncol,2006,4:12.[5]TempferCB,PolterauerS,BentzEK,etal.Accuracyofintraoperativefrozensectionanalysisinborderlinetumorsoftheovary:aretrospectiveanalysisof96casesandreviewoftheliterature[J].GynecolOncol,2007,107(2):248-252.[6]CamatteS,MoriceP,PautierP,etal.Fertilityresultsafterconservativetreatmentofadvancedstageserousborderlinetumoursoftheovary[J].BJOG,2002,109(4):376-3801.卵巢交界性腫瘤治療四、卵巢交界性腫瘤治療及預(yù)后[7]CamatteS,MoriceP,AtallahD,etal.Lymphnodedisordersandprognosticualueofnodalinvolvementinpatientstreatedforaborderlineovariantumor:ananalysisofaseriesof42lymphadenectomies[J].AmCollSurg,2002,195(3):332-3381.卵巢交界性腫瘤治療四、卵巢交界性腫瘤治療及預(yù)后[7]CamatteS,MoriceP,AtallahD,etal.Lymphnodedisordersandprognosticualueofnodalinvolvementinpatientstreatedforaborderlineovariantumor:ananalysisofaseriesof42lymphadenectomies[J].AmCollSurg,2002,195(3):332-338.[8]RomagnoloC,GadducciA,SartoriE,etal.Managementofborderlineovariantumors:ResultsofanItalianmulticenterstudy[J].GynecolOncol,2006,101(2):255-260.[9]VandenputI,AmantF,VergoteI.Peritonealrecurrencesmightbelesscommoninadvancedstageserousborderlineovariantumorsthatweretreatedbylaparotomy[J].GynecolOncol,2005,98(3):523-525.1.卵巢交界性腫瘤治療四、卵巢交界性腫瘤治療及預(yù)后1.卵巢交界性腫瘤治療四、卵巢交界性腫瘤治療及預(yù)后（4）化療

VAC方案PP方案PC方案化療方案（腹腔化療優(yōu)于靜脈化療）1.卵巢交界性腫瘤治療四、卵巢交界性腫瘤治療及預(yù)后（4）化療PC方案：順鉑P1.卵巢交界性腫瘤治療四、卵巢交界性腫瘤治療及預(yù)后（4）化療PP方案：紫杉醇P順鉑PPaclitaxel135mg/m2ivdropqd紫杉醇（P）135mg/m2

靜滴每日一次每四周重復(fù)一次Cisplatin70mg/m2ivdropqd順鉑(P)70mg/m2

靜滴每日一次1.卵巢交界性腫瘤治療四、卵巢交界性腫瘤治療及預(yù)后（4）化療PP方案：長(zhǎng)春新堿V放線菌素DA1.卵巢交界性腫瘤治療四、卵巢交界性腫瘤治療及預(yù)后1.卵巢交界性腫瘤治療四、卵巢交界性腫瘤治療及預(yù)后1.卵巢交界性腫瘤治療四、卵巢交界性腫瘤治療及預(yù)后[10]FortinA,MoriceP,ThouryA,etal.Impactofinfertilitydrugsaftertreatmentofborderlineovariantumors:Resultsofaretrospectivemulticenterstudy[J].FertilSter