卵巢交界性肿瘤的临床特征及危险因素分析

杨佳; 嵇梦颖; 李雨荆; 孙莹; 晋一超; 纪统慧; 王秀丽; 戴辉华

doi:10.7619/jcmp.20213184

卵巢交界性肿瘤的临床特征及危险因素分析

1.
南京医科大学, 江苏南京, 210000
2.
南京医科大学第一附属医院妇科, 江苏南京, 210000

基金项目:

江苏省妇幼健康科研项目 F201921

详细信息

通讯作者:
戴辉华, E-mail: daihuihua65@163.com

中图分类号: R737.31;R713.6
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- 文章访问数: 245
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- PDF下载量: 10
出版历程
- 收稿日期: 2021-08-06
- 网络出版日期: 2022-03-21
- 发布日期: 2022-02-27

Clinical characteristics and risk factors of borderline ovarian tumors

1.
Nanjing Medical University, Nanjing, Jiangsu, 210000
2.
Department of Gynecology, the First Affiliated Hospital of Nanjing Medical University, Nanjing, Jiangsu, 210000

摘要

摘要:
目的分析卵巢交界性肿瘤(BOTs)的危险因素和临床特征。
方法选取275例经手术病理确诊BOTs患者作为研究对象, 另随机选取275例经手术病理确诊卵巢良性上皮性肿瘤(BETs)患者进行病例对照研究。收集并比较患者的年龄、生育情况、症状体征、超声影像学检查结果、血清肿瘤标志物水平、手术记录及病理结果等临床资料，分析BOTs的危险因素。根据术后病理类型将部分BOTs患者分为卵巢交界性黏液性肿瘤(MBOTs)组和卵巢交界性浆液性肿瘤(SBOTs)组，比较2组患者的临床特征。
结果超声显示成分以实性为主、囊壁有乳头、有血流信号、糖类抗原125(CA125)及糖类抗原199(CA199)升高均为BOTs的独立危险因素(P < 0.05); BOTs与BETs在肿瘤最大径、肿瘤位置、是否多房和血清癌胚抗原水平方面比较，差异无统计学意义(P > 0.05)。MBOTs组超声显示肿瘤最大径≥10 cm、多房、有血流信号和CA199升高者占比均高于SBOTs组，超声显示肿瘤位于双侧、有乳头和CA125升高者占比均低于SBOTs组，差异有统计学意义(P < 0.05)。
结论 BOTs患者超声检查显示以实性成分为主、多房、有乳头、有血流信号且血清CA125、CA199水平升高，临床可据此与BETs相鉴别。肿瘤最大径≥10 cm、多房、有血流信号提示MBOTs可能性大; MBOTs更易出现CA199升高, SBOTs更易出现CA125升高。
- 卵巢交界性肿瘤 /
- 超声检查 /
- 肿瘤标志物 /
- 卵巢交界性黏液性肿瘤 /
- 卵巢交界性浆液性肿瘤
Abstract:
Objective To analyze the risk factors and the clinical characteristics of borderline ovarian tumors(BOTs).
Methods A total of 275 patients who were diagnosed as BOTs were selected as study objects. Another 275 patients diagnosed as ovarian benign epithelial tumor (BETs) by surgical pathology were selected as controls. The clinical data such as age, fertility, symptoms and signs, results of ultrasonography, serum tumor markers, surgical and pathological results were collected and compared. The risk factors of BOTs were analyzed. According to postoperative pathological types, some BOTs patients were divided into mucinous borderline ovarian tumors (MBOTs) group and serous borderline ovarian tumors (SBOTs) group, and the clinical characteristics of the two groups were compared.
Results Ultrasonographic findings showed that solid tumor, papilla-shaped protuberance on the cystic wall, blood flow signals and elevated carbohydrate antigen 125 (CA125) and carbohydrate antigen 199(CA199) were independent risk factors for BOTs. Compared with BETs, there were no significant differences in tumor maximum diameter, location of tumors, multilocular tumors, and serum carcinoembryonic antigen level in BOTs(P > 0.05). The proportions of the maximal diameter ≥10 cm, multilocular tumors, blood flow signal and the increased CA199 in patients of the MBOTs group were higher than those in the SBOTs group, while the proportions of bilateral tumor, papilla-shaped protuberance on the cystic wall and elevated CA125 were lower than those in the SBOTs group(P < 0.05).
Conclusion The ultrasonographic findings show that solid components, multilocular tumors, papilla-shaped protuberance, blood flow signal and elevated serum levels of CA125 and CA199 occur in BOTs patients, and they are helpful to distinguish BOTs from BETs. The maximum diameter of the tumor ≥10 cm, multilocular tumors and blood flow signal suggest higher possibility of MBOTs. MBOTs patients are more likely to have elevated CA199, while those with SBOTs are more likely to have elevated CA125.
- borderline ovarian tumors /
- ultrasonography /
- tumor markers /
- mucinous borderline ovarian tumors /
- serous borderline ovarian tumors

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表 1 BOTs患者与BETs患者资料的单因素分析[n(%)]

因素		BOTs(n=275)	BETs(n=275)	χ²	P	OR	95%CI
肿瘤最大径	≥10 cm	114(41.45)	67(24.36)	17.425	< 0.001	2.198	1.526~3.167
	< 10 cm	161(58.55)	208(75.64)
肿瘤位置	双侧	38(13.82)	19(6.91)	6.341	0.011	2.160	1.212~3.852
	单侧	237(86.18)	256(93.09)
成分以实性为主	是	120(43.64)	12(4.36)	114.125	< 0.001	16.968	9.076~31.723
	否	155(56.36)	263(95.64)
乳头	有	135(49.09)	36(13.09)	81.504	< 0.001	6.402	4.195~9.770
	无	140(50.91)	239(86.91)
多房	是	100(36.36)	36(13.09)	38.771	< 0.001	3.794	2.473~5.820
	否	175(63.64)	239(86.91)
血流信号	有	125(45.45)	27(9.82)	85.542	< 0.001	7.654	4.819~12.158
	无	150(54.55)	248(90.18)
CA125	升高	110(40.00)	14(5.09)	93.968	< 0.001	12.429	6.894~22.406
	不升高	165(60.00)	261(94.91)
CA199	升高	52(18.91)	12(4.36)	26.895	< 0.001	5.111	2.661~9.815
	不升高	223(81.09)	263(95.64)
CEA	升高	6(2.18)	4(1.45)	0.102	0.752	1.511	0.422~5.415
	不升高	269(97.82)	271(98.55)
BOTs: 卵巢交界性肿瘤; BETs: 卵巢良性上皮性肿瘤; CA125: 糖类抗原125; CA199: 糖类抗原199; CEA: 癌胚抗原。

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表 2 MBOTs组与SBOTs组资料的单因素分析结果

因素		MBOTs(n=112)	SBOTs(n=131)	χ²	P	OR	95%CI
肿瘤最大径	≥10 cm	81(72.32)	26(19.85)	65.305	< 0.001	10.552	5.812~19.158
	< 10 cm	31(27.68)	105(80.15)
肿瘤位置	双侧	3(2.68)	29(22.14)	18.328	< 0.001	0.097	0.029~0.328
	单侧	109(97.32)	102(77.86)
成分以实性为主	是	48(42.86)	73(55.73)	3.501	0.054	0.596	0.358~0.991
	否	64(57.14)	58(44.27)
乳头	有	46(41.07)	75(57.25)	5.692	0.014	0.520	0.312~0.868
	无	66(58.93)	56(42.75)
多房	是	67(59.82)	25(19.08)	40.877	< 0.001	6.313	3.546~11.238
	否	45(40.18)	106(80.92)
血流信号	有	65(58.04)	53(40.46)	6.781	0.007	2.035	1.219~3.398
	无	47(41.96)	78(59.54)
CA125	升高	33(29.46)	63(48.09)	8.004	0.004	0.451	0.265~0.767
	不升高	79(70.54)	68(51.91)
CA199	升高	28(25.00)	13(9.92)	8.739	0.002	3.026	1.480~6.184
	不升高	84(75.00)	118(90.08)
CEA	升高	6(5.36)	1(0.76)	3.060	0.051	7.358	0.872~62.075
	不升高	106(94.64)	130(99.24)
MBOTs: 卵巢交界性黏液性肿瘤; SBOTs: 卵巢交界性浆液性肿瘤; CA125: 糖类抗原125; CA199: 糖类抗原199; CEA: 癌胚抗原。

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表 3 BOTs危险因素的多因素Logistic回归分析

因素	P	OR	95%CI
肿瘤最大径≥10 cm	0.138	1.495	0.879~2.544
双侧	0.894	1.062	0.436~2.590
成分以实性为主	< 0.001	10.848	5.291~22.243
有乳头	< 0.001	6.962	4.134~11.722
多房	0.164	1.468	0.855~2.519
有血流信号	< 0.001	3.202	1.792~5.704
CA125升高	< 0.001	6.165	3.022~12.578
CA199升高	0.031	2.537	1.090~5.904
BOTs: 卵巢交界性肿瘤; CA125: 糖类抗原125; CA199: 糖类抗原199。

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表 4 MBOTs影响因素的多因素Logistic回归分析

因素	P	OR	95%CI
肿瘤最大径≥10 cm	< 0.001	8.358	3.897~17.926
双侧	0.008	0.145	0.035~0.610
成分以实性为主	0.309	1.471	0.700~3.090
有乳头	0.021	0.438	0.218~0.881
多房	< 0.001	4.045	1.953~8.380
有血流信号	0.031	2.145	1.070~4.298
CA125升高	< 0.001	0.169	0.072~0.395
CA199升高	0.013	3.582	1.308~9.807
MBOTs: 卵巢交界性黏液性肿瘤; CA125: 糖类抗原125; CA199: 糖类抗原199。

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