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目的探讨卵巢正常大小的癌综合征(NOCS)临床病理特征、存活率及预后影响因素,分析NOCS分子标志物的表达。方法对1992~2002年河北医科大学第四医院收治的55例NOCS患者进行回顾性分析,用免疫组化SP法检测CA125、Ber-EP4、Calretinin和CK7在卵巢癌和NOCS中的表达。结果NOCS占同期卵巢癌的6.56%,且近几年有上升趋势。NOCS患者初诊至手术的平均时间为(127.8±25.6)d,而卵巢癌患者的相应时间为(58.7±57.6)d,两者比较差异有显著性意义(t=2.01,P<0.05)。阴道超声对NOCS的诊断准确率为93.5%。化疗≥3疗程、残留灶直径<2cm者的平均生存时间与化疗<3疗程、残留灶直径≥2cm者比较差异有显著性意义(P<0.05)。患者术后平均生存时间与年龄、腹水量、临床分期、病理分级无关。NOCS的1年、3年、5年存活率分别为67.9%、29.1%、10.2%。CA125和Ber-EP4在卵巢原发癌中的表达高于卵巢外腹膜浆液性乳头状癌(EP-SPC)中的表达(P<0.01,P<0.05),而在卵巢癌和卵巢原发癌中的表达差异无显著性意义。结论卵巢原发癌是NOCS的主要组成成分。50岁以上的中老年妇女出现不明原因的消化道症状、伴有大量腹水、妇科检查触不到肿块,应考虑到NOCS,及时行阴道彩色超声等检查及剖腹探查术。
Objective To investigate the clinicopathological characteristics, survival rate and prognostic factors of normal ovarian cancer (NOCS), and to analyze the expression of NOCS molecular markers. Methods 55 patients with NOCS admitted to the Fourth Hospital of Hebei Medical University from 1992 to 2002 were retrospectively analyzed. The expressions of CA125, Ber-EP4, Calretinin and CK7 in ovarian cancer and NOCs were detected by immunohistochemical SP method. Results NOCS accounted for 6.56% of ovarian cancer in the same period, and in recent years there is an upward trend. The average time from initial diagnosis to operation of patients with NOCS was (127.8 ± 25.6) d, while that of patients with ovarian cancer was (58.7 ± 57.6) d. The difference was significant (t = 2.01, P <0.05). The diagnostic accuracy of vaginal ultrasound on NOCS was 93.5%. The average survival time of patients with residual tumor less than 2cm in duration of chemotherapy ≥3 and the course of chemotherapy less than 3cm and the residual diameter ≥2cm were significant (P <0.05). The average postoperative survival time was independent of age, ascites volume, clinical stage and pathological grade. The 1-year, 3-year and 5-year survival rates of NOCS were 67.9%, 29.1% and 10.2% respectively. The expression of CA125 and Ber-EP4 in primary ovarian cancer was higher than that in ovarian extraperitoneal serous papillary carcinoma (EP-SPC) (P <0.01, P <0.05), while in ovarian and ovarian primary carcinomas In the expression of no significant difference. Conclusion The primary ovarian cancer is the main component of NOCS. Older women over 50 years of age with unknown causes of gastrointestinal symptoms, accompanied by a large number of ascites, gynecological examination touched the mass should take into account the NOCS, timely color vaginal ultrasound and laparotomy.