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目的探讨卵巢浆液性腺癌(OSA)的临床病理学特征和MDACC分级的适用性。方法回顾性分析72例OSA临床病理资料,分别进行MDACC和WHO分级,结合临床参数进行统计学分析。运用直接测序法检测5例卵巢交界性浆液性肿瘤(OBST)、10例低级别OSA和5例高级别OSA中KRAS及BRAF基因。结果 MDACC低级别14例,高级别58例;WHOⅠ级10例,Ⅱ级16例,Ⅲ级46例。MDACC低级别和高级别患者的平均年龄差异显著(P<0.05),WHO分组3组间差异不显著。MDACC分级与OSA复发、pTNM分期、3年存活期显著相关(P<0.05)。WHO分级仅与OSA复发显著相关(P<0.05)。OBST中检测到1例BRAF基因突变;低级别OSA中检测出1例KRAS基因突和1例BRAF基因突变,后者OSA旁OBST区域也检测到BRAF基因突变;5例高级别OSA中未检测到这2种突变。结论 MDACC分级在与临床参数的联系上比WHO分级更紧密,且与OSA分子生物学发病机制具有更高的相关性,在临床运用上有更广阔的前景。
Objective To investigate the clinical and pathological features of ovarian serous adenocarcinoma (OSA) and the applicability of MDACC classification. Methods A retrospective analysis of 72 cases of OSA clinical and pathological data, respectively, MDACC and WHO classification, combined with clinical parameters for statistical analysis. Five cases of ovarian borderline serous tumor (OBST), 10 low-grade OSA and 5 high-grade OSA KRAS and BRAF genes were detected by direct sequencing. Results The low grade of MDACC was 14 cases and the high grade was 58 cases. There were 10 cases of WHOⅠ, 16 cases of Ⅱ and 46 cases of Ⅲ. The average age of patients with MDACC in low-grade and high-grade patients was significantly different (P <0.05), but there was no significant difference between the three groups in WHO group. There was a significant correlation between MDACC classification and OSA recurrence, pTNM stage and 3-year survival (P <0.05). The WHO classification was only significantly associated with OSA recurrence (P <0.05). One case of BRAF gene mutation was detected in OBST. One case of KRAS gene mutation and one case of BRAF gene mutation were detected in low-grade OSA. BRAF gene mutation was also detected in OBST region adjacent to OSA. Five cases of high-grade OSA were not detected These two kinds of mutations. Conclusion The classification of MDACC is more closely related to the clinical parameters than the WHO classification and has a higher correlation with the molecular pathogenesis of OSA. It has a broader perspective in clinical application.