基于病例报道腹壁子宫内膜异位症透明细胞癌变相关预后因素分析

doi:10.12280/gjfckx.20231109

摘要/Abstract

摘要：

目的： 探讨影响腹壁子宫内膜异位症透明细胞癌变（abdominal wall endometriosis associated clear cell carcinoma，AWE-CCC）患者预后的相关因素。方法： 系统检索PubMed、EMBASE、MEDLINE、Google Scholar、Cochrane Library、万方、维普及中国知网数据库中包含AWE-CCC的相关文献，检索时间范围为1980年1月—2023年9月。使用Kaplan-Meier单因素生存分析及多因素Cox分析影响预后的因素，使用Apriori算法总结临床治疗规则。结果： 纳入68例AWE-CCC患者。年龄≤46岁、病灶直径>8 cm、病灶复发及复发间隔≤6个月是影响患者生存的不良预后因素（均P<0.05）。子宫切除对患者复发具有保护作用（HR=0.08，95%CI：0.01~0.81，P=0.03），且病灶切除联合子宫切除是强关联治疗规则。结论： 在临床实践中，应重视患者年龄和病灶大小，初始治疗应包含病灶切除及子宫切除为基础的联合手术治疗以减少术后复发。

关键词: 腹壁, 子宫内膜异位症, 腺癌, 透明细胞, 预后, 影响因素分析

Abstract:

Objective: To explore the prognostic factors associated with clear cell carcinoma of abdominal wall endometriosis (AWE-CCC). Methods: A systematic literature search for case reports on AWE-CCC was performed in PubMed, EMBASE, MEDLINE, Google Scholar, Cochrane Library, Wanfang, VIP and China National Knowledge Infrastructure (CNKI) from January 1980 to September 2023. Kaplan-Meier univariate survival analysis and multivariate Cox analysis were utilized to screen for factors affecting prognosis, and clinical treatment rules were summarized using the Apriori algorithm. Results: A total of 68 patients with AWE-CCC were included in this analysis. age ≤46 years old, lesion diameter >8 cm, lesion recurrence and recurrence interval≤6 months might be poor prognostic factors for AWE-CCC (P<0.05). Lesion excision plus hysterectomy were a strong therapeutic association rule and hysterectomy could offer recurrence protection (HR=0.08, 95%CI: 0.01-0.81, P=0.03). Conclusions: In clinical practice, patient′s age and lesion size should be emphasized. The initial treatment should include lesion excision and hysterectomy-based combined surgical treatment to reduce postoperative recurrence.

Key words: Abdominal wall, Endometriosis, Adenocarcinoma, clear cell, Prognosis, Root cause analysis

虞梁, 袁琳, 孟黄洋, 杨雨琴, 赵明睿, 张林, 程文俊. 基于病例报道腹壁子宫内膜异位症透明细胞癌变相关预后因素分析[J]. 国际妇产科学杂志, 2024, 51(2): 220-227.

YU Liang, YUAN Lin, MENG Huang-yang, YANG Yu-qin, ZHAO Ming-rui, ZHANG Lin, CHENG Wen-jun. The Prognosis Factors Abdominal Wall Endometriosis Associated Clear Cell Carcinoma: A Pooled Analysis Based on Case Reports[J]. Journal of International Obstetrics and Gynecology, 2024, 51(2): 220-227.

图/表 5

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人群基本特征	报道情况	n	M（P₂₅，P₇₅）或%
患者年龄（岁）	已知	68	46（42，53）
病灶最大直径（cm）	已知	57	9（6，13）
	未知	11	—
病灶诊断延迟时间（年）	已知	48	17（13，22）
	未知	20	—
诊断恶变前CA125状态	≤35 U/mL	30	44.2
	>35 U/mL	19	27.9
	未知	19	27.9
AWE-CCC相关治疗方式
病灶切除	接受	66	97.1
	未接受	2	2.9
子宫切除	接受	44	64.7
	未接受	24	35.3
附件切除	接受	44	64.7
	未接受	24	35.3
大网膜切除	接受	23	33.8
	未接受	45	66.2
淋巴结切除	接受	22	32.4
	未接受	46	67.6
辅助化疗	接受	51	75.0
	未接受	17	25.0
辅助放疗	接受	19	27.9
	未接受	49	72.1
病灶切缘受累状态	阳性	6	8.8
	阴性	24	35.3
	未知	38	55.9
淋巴结受累状态	阳性	18	26.5
	阴性	7	10.3
	未知	43	63.2
恶变复发情况	复发	27	39.7
	未复发	30	44.1
	未知	11	16.2
生存情况	生存	54	79.4
	死亡	14	20.6

人群基本特征	报道情况	n	M（P₂₅，P₇₅）或%
患者年龄（岁）	已知	68	46（42，53）
病灶最大直径（cm）	已知	57	9（6，13）
	未知	11	—
病灶诊断延迟时间（年）	已知	48	17（13，22）
	未知	20	—
诊断恶变前CA125状态	≤35 U/mL	30	44.2
	>35 U/mL	19	27.9
	未知	19	27.9
AWE-CCC相关治疗方式
病灶切除	接受	66	97.1
	未接受	2	2.9
子宫切除	接受	44	64.7
	未接受	24	35.3
附件切除	接受	44	64.7
	未接受	24	35.3
大网膜切除	接受	23	33.8
	未接受	45	66.2
淋巴结切除	接受	22	32.4
	未接受	46	67.6
辅助化疗	接受	51	75.0
	未接受	17	25.0
辅助放疗	接受	19	27.9
	未接受	49	72.1
病灶切缘受累状态	阳性	6	8.8
	阴性	24	35.3
	未知	38	55.9
淋巴结受累状态	阳性	18	26.5
	阴性	7	10.3
	未知	43	63.2
恶变复发情况	复发	27	39.7
	未复发	30	44.1
	未知	11	16.2
生存情况	生存	54	79.4
	死亡	14	20.6

因素		2年累计死亡率[%（a/n）]	P
患者年龄	≤46岁	25.71（9/33）	0.021
	>46岁	9.09（3/35）
病灶最大直径	≤8 cm	7.14（2/28）	0.045
	>8 cm	27.59（8/29）
诊断恶变前CA125	≤35 U/mL	16.67（5/30）	0.138
	>35 U/mL	26.32（5/19）
病灶切缘受累状态	阳性	33.33（2/6）	0.254
	阴性	12.50（3/24）
淋巴结受累状态	阳性	27.78（5/18）	0.088
	阴性	0.00（0/7）
复发状态	复发	14.81（4/27）	0.036
	未复发	0.00（0/30）
DFS	≤6个月	23.08（3/13）	0.038
	>6个月	7.14（1/14）

因素		2年累计死亡率[%（a/n）]	P
患者年龄	≤46岁	25.71（9/33）	0.021
	>46岁	9.09（3/35）
病灶最大直径	≤8 cm	7.14（2/28）	0.045
	>8 cm	27.59（8/29）
诊断恶变前CA125	≤35 U/mL	16.67（5/30）	0.138
	>35 U/mL	26.32（5/19）
病灶切缘受累状态	阳性	33.33（2/6）	0.254
	阴性	12.50（3/24）
淋巴结受累状态	阳性	27.78（5/18）	0.088
	阴性	0.00（0/7）
复发状态	复发	14.81（4/27）	0.036
	未复发	0.00（0/30）
DFS	≤6个月	23.08（3/13）	0.038
	>6个月	7.14（1/14）

因素		P	HR（95%CI）
年龄	≤46岁	-	-
	>46岁	0.88	1.07（0.48~2.38）
子宫切除	否	-	-
	是	0.03	0.08（0.01~0.81）
附件切除	否	-	-
	是	0.06	9.64（0.92~100.97）
大网膜切除	否	-	-
	是	0.99	1.00（0.38~2.66）
淋巴结切除	否	-	-
	是	0.23	1.78（0.70~4.53）
辅助放疗	否	-	-
	是	0.99	1.00（0.34~2.94）
辅助化疗	否	-	-
	是	0.34	1.81（0.54~6.10）