Characteristics and Prognostic Factors of Ovarian Metastasis from Colorectal Cancer

大腸癌合倂卵巢轉移之臨床表現及預後因子

鄭厚軒(Hou-Hsuan Cheng) ； 林宏鑫(Hung-Hsin Lin) ； 林春吉(Chun-Chi Lin) ； 藍苑慈(Yuan-Tzu Lan) ； 張世慶(Shin-Ching Chang) ； 王煥昇(Huann-Sheng Wang) ； 姜正愷(Jeng-Kai Jiang) ； 陳維熊(Wei-Shone Chen) ； 林資琛(Tzu-Chen Lin) ； 林楨國(Jen-Kou Lin) ； 楊純豪(Shung-Haur Yang) ； 陳周斌(Joe-Bin Chen)

《中華民國大腸直腸外科醫學會雜誌》 27卷1期 (2016/03) Pp. 15-22

https://doi.org/10.6312/SCRSTW.2016.27(1).10415

摘要

目的：大腸癌合併卵巢轉移在臨床上屬於少見案例。針對此群少數病患進行臨床特徵及相關因子做預後分析。方法：自2002至2012年間，台北榮民總醫院與台中榮民總醫院共有90位病患接受大腸癌及卵巢切除手術，其中有55位(61.1%)為同時性，有35位(38.9%)為異時性，此篇文章針對這90病患進行回顧性研究分析。結果：在這90位病患中，平均年齡為51歲。從發現卵巢轉移到死亡的時間中位數為24.3個月。同時性卵巢轉移的病患比異時性的病患有較高的比例合併卵巢以外的轉移及較低的腫瘤完全切除率，但兩者的存活率則差不多。這些腫瘤的T stage都在T3以上。CEA及CA-125對於卵巢轉移的敏感度分別為72.2% (65/90)及65.5% (36/55)。兩側卵巢侵犯的比例為65.8%。最常見的卵巢外轉移依序是腹膜轉移(45.5%)、肝臟(23.3%)、肺臟(17.8%)及後腹腔淋巴結(16.7%)。卵巢切除前CEA升高、T4及腫瘤細胞沿著神經生長散布為多變項存活分析的預後因子。結論：不論在異時性或是同時性轉移的病人，大腸癌合併卵巢轉移之後的存活時間約為兩年。卵巢轉移的病人因兩側轉移的機會較高，建議行兩側卵巢切除。卵巢切除前CEA升高、T4及腫瘤細胞沿著神經生長散布為多變項存活分析的預後因子。

關鍵字

大腸癌 ； 卵巢轉移 ； 異時性 ； 同時性

並列摘要

Purpose. Ovarian metastasis (OM) was uncommon in colorectal cancer (CRC). The aim of this study was to evaluate its characteristics and prognostic factors through a retrospective analysis. Methods. Between April 2002 and March 2012, 90 cases including 55 (61.1%) synchronous and 35 (38.9%) metachronousreceiving oophorectomy due to metastasis from CRC in Taipei Veterans General Hospitaland Taichung Veterans General Hospitalwere reviewed. The clinicopathologic data and prognosis were analyzed. Results. Median age was 51 years. Median duration of survival after OM was 24.3 months. Synchronous group had higher extent of extra-ovary metastasis and lower R0 resection rate than metachronous group, but similar survival curves since diagnosis of OM. None of the T status of primaryCRC was less than T3. The sensitivity of CEA(5 ng/ml) and CA-125 (37 u/mL) in OM was 72.2% (65/90), and 65.5% (36/55) respectively. Bilateral ovarian involvement was noted in 65.8%. Peritoneal seeding was the most common site of concurrent metastasis (45.5%), followed by liver (23.3%), lung (17.8%) and retroperitoneal lymphadenopathy (16.7%). CEA before oophorectomy, T4 stage and perineural invasion of primary tumor reached significance in multivariate analysis. Conclusions. Median duration of survival after OM was 2 years without difference between synchronous and metachronous groups. Bilateral oophorectomy should be suggested to all cases of OMbecause of the high incidence of bilateral involvement. T4 status and perineural invasion of primary tumor, and pre-oophorectomy CEA were three independent prognostic factors of CRC origin OM.

並列關鍵字

Colorectal cancer ； Ovarian metastasis ； Synchronous ； Metachronous

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