目的:分析35岁以下女性与60-79岁女性上皮性卵巢癌(EOC)的潜在预后因素。
方法:病例来自SEER数据库。临床特征,比如种族,组织学类型,AJCC阶段,肿瘤的侧向性,CA125结果,和手术策略,在<35岁组和60-79岁组中进行了分析。使用Kaplan-Meier存活曲线评估总生存期(OS)和原因特异性生存期(CSS)。Cox比例风险模型用于确定CSS的预测因子。
结果:从SEER数据库中确定了2004-2015年诊断出的1.67万名EOC患者,年龄在35岁以下的1,015人和年龄在60-79岁的15,833人。在<35岁组,粘液性(32.2%)是最常见的组织学类型,其次是高级别浆液性(26.6%)和子宫内膜样(18.3%),而在60-79岁的人群中,高级别浆液性(68.3%)是主要的组织学类型。大多数年轻女性被诊断为I期(57.7%),而大多数老年妇女被诊断为分期(48.1%)。<35年组的5年OS和5年CSS均较高(5年OS:76.00%vs40.18%,p<0.001;5年CSS:83.56%对55.18%,p<0.001)。多变量分析将组织学类型和分期确定为两组CSS的预后因素。子宫内膜样对CSS是一个积极的预测因子,而癌肉瘤和恶性Brenner与CSS恶化有关。(<35岁组:癌肉瘤与子宫内膜样:HR5.630,p=0.024;恶性Brenner与子宫内膜样:HR4.005,p<0.001;60-79岁组:癌肉瘤与子宫内膜样:HR3.606,p<0.001;恶性Brenner与子宫内膜样:HR2.291,p<0.001)。肿瘤侧向性,CA125水平,手术和淋巴结清扫术未能与<35岁组的CSS相关联,而发现是60-79岁组的独立危险因素。
结论:35岁以下的EOC女性比60-79岁的EOC女性有更好的生存结局,因为在组织学上子宫内膜样和粘液性类型的比例很高,以及早期诊断。在年轻的EOC患者中,应强调组织学类型和基因谱的鉴定。
OBJECTIVE: To analyze the potential prognostic factors of epithelial ovarian cancer (EOC) in women aged under 35 compared to those aged 60-79.
METHODS: Cases were retrospectively obtained from SEER database. Clinical characteristics, such as race, histological type, AJCC stage, laterality of tumors, CA125 results, and surgical strategies, were analyzed in < 35 years group and 60-79 years group. Kaplan-Meier survival curves were used to evaluate overall survival (OS) and cause-specific survival (CSS). Cox proportional hazard model was used to identify the predictors for CSS.
RESULTS: Sixteen thousand eight hundred forty-seven EOC patients diagnosed in 2004-2015 were identified from SEER database, with 1,015 aged under 35 and 15,833 aged 60-79. In < 35 years group, mucinous (32.2%) was the most common histological type, followed by high-grade serous (26.6%) and endometrioid (18.3%), while in 60-79 years group, high-grade serous (68.3%) represented the leading histological type. Most young women were diagnosed at stage I (57.7%), while most old women were diagnosed at stage (48.1%). Both 5-year OS and 5-year CSS were higher in < 35 years group (5-year OS: 76.00% vs 40.18%, p < 0.001; 5-year CSS: 83.56% vs 55.18%, p < 0.001). The multivariate analysis identified histological type and stage as prognostic factors for CSS in both groups. Endometrioid represented a positive predictor for CSS, while carcinosarcoma and malignant Brenner were related to a worse CSS. (< 35 years group: carcinosarcoma vs endometrioid: HR 5.630, p=0.024; malignant Brenner vs endometrioid: HR 4.005, p < 0.001; 60-79 years group: carcinosarcoma vs endometrioid: HR 3.606, p < 0.001; malignant Brenner vs endometrioid: HR 2.291, p < 0.001). Tumors laterality, CA125 levels, surgery and lymphadenectomy failed to be associated with the CSS in < 35 years group, while found to be independent risk factors in 60-79 years group.
CONCLUSIONS: EOC women aged under 35 had a better survival outcome over EOC women aged 60-79, owing to high proportion of endometrioid and mucinous types in histology, as well as early-stage diagnosis. Identification of histological types and gene profiles should be underscored in young EOC patients.