[1].黏液性卵巢癌诊断与治疗中国专家共识（2021年版）[J].中国微创外科杂志,2021,01(7):577-588.
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黏液性卵巢癌诊断与治疗中国专家共识（2021年版）()
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《中国微创外科杂志》[ISSN:1009-6604/CN:11-4526/R]

卷:
01
期数:
2021年7期
页码:
577-588
栏目:
共识与指南
出版日期:
2021-07-25

文章信息/Info

作者:
中国研究型医院学会腹膜后与盆底疾病专业委员会
关键词:
黏液性卵巢癌; 诊断与治疗; 专家共识
文献标志码:
C
摘要:
黏液性卵巢癌（mucinous ovarian cancer，MOC）是上皮性卵巢癌（epithelial ovarian carcinoma，EOC）的组织学亚型之一，占EOC 3%~5%，具有独特的临床、组织病理学和分子生物学特征，常见于中青年女性，多认为MOC由交界性黏液性肿瘤恶变而来，典型表现为单侧卵巢巨大、单房或多房性囊肿，内充满黏液。早期MOC预后较好，晚期MOC对化疗不敏感，预后较差。手术是MOC主要治疗手段，早期患者施行全面分期手术，晚期患者需要接受肿瘤细胞减灭术，力争达到无残留病灶（R0）。手术方式首选开腹手术，有生育要求的Ⅰ期MOC可施行保留生育功能的分期手术。ⅠA~ⅠB期患者术后可观察，ⅠC期患者可选择化疗或观察；Ⅱ期及以上患者需辅助以铂类为基础联合化疗或参考胃肠型肿瘤化疗方案，腹腔热灌注化疗（hyperthermic intraperitoneal chemotherapy，HIPEC）可提高缓解率。复发性MOC的二次减瘤术存有争议。VEGF抑制剂、EGFR单抗、抗HER2治疗是未来探索的方向。

参考文献/References:

[1]Sung H, Ferlay J, Siegel RL, et al. Global cancer statistics 2020: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries. CA Cancer J Clin,2021,71（3）：209-249.
[2]Shimada M, Kigawa J, Ohishi Y, et al. Clinicopathological characteristics of mucinous adenocarcinoma of the ovary. Gynecol Oncol,2009,113(3):331-334.
[3]Seidman JD, Kurman RJ, Ronnett BM. Primary and metastatic mucinous adenocarcinomas in the ovaries: incidence in routine practice with a new approach to improve intraoperative diagnosis. Am J Surg Pathol,2003,27(7):985-993.
[4]Peres LC, CushingHaugen KL, Kbel M, et al. Invasive epithelial ovarian cancer survival by histotype and disease stage. J Natl Cancer Inst,2019,111(1):60-68.
[5]Kbel M, Kalloger SE, Huntsman DG, et al. Differences in tumor type in lowstage versus highstage ovarian carcinomas. Int J Gynecol Pathol,2010,29(3):203-211.
[6]Kelemen LE, Kbel M. Mucinous carcinomas of the ovary and colorectum: different organ, same dilemma. Lancet Oncol,2011,12(11):1071-1080.
[7]Vang R, Khunamornpong S, Kobel M, et al. WHO Classification of Tumours of the Female Genital Tumours. 5th ed. Lyon: International Agency for Research on Cancer,2020.48-53.
[8]Jordan SJ, Green AC, Whiteman DC, et al. Risk factors for benign, borderline and invasive mucinous ovarian tumors: epidemiological evidence of a neoplastic continuum? Gynecol Oncol, 2007,107(2):223-230.
[9]Wagner BJ, Buck JL, Seidman JD, et al. From the archives of the AFIP. Ovarian epithelial neoplasms: radiologicpathologic correlation. Radiographics,1994,14(6):1351-1376.
[10]Hess V, A′hern R, Nasiri N, et al. Mucinous epithelial ovarian cancer: a separate entity requiring specific treatment. J Clin Oncol,2004,22(6):1040-1044.
[11]Lee KR, Scully RE. Mucinous tumors of the ovary: a clinicopathologic study of 196 borderline tumors (of intestinal type) and carcinomas, including an evaluation of 11 cases with ‘pseudomyxoma peritonei’. Am J Surg Pathol,2000,24(11):1447-1464.
[12]Prat J, D′angelo E, Espinosa I. Ovarian carcinomas: at least five different diseases with distinct histological features and molecular genetics. Hum Pathol,2018,80:11-27.
[13]Muyldermans K, Moerman P, Amant F, et al. Primary invasive mucinous ovarian carcinoma of the intestinal type: importance of the expansile versus infiltrative type in predicting recurrence and lymph node metastases. Eur J Cancer,2013,49(7):1600-1608.
[14]Lee KR, Young RH. The distinction between primary and metastatic mucinous carcinomas of the ovary: gross and histologic findings in 50 cases. Am J Surg Pathol,2003,27(3):281-292.
[15]Siegel RL, Miller KD, Jemal A. Cancer statistics, 2019. CA Cancer J Clin,2019,69(1):7-34.
[16]Kajiyama H, Suzuki S, Utsumi F, et al. Comparison of longterm oncologic outcomes between metastatic ovarian carcinoma originating from gastrointestinal organs and advanced mucinous ovarian carcinoma. Int J Clin Oncol,2019,24(8):950-956.
[17]Babaier A, Ghatage P. Mucinous cancer of the ovary: Overview and current status. Diagnostics (Basel),2020,10(1):52
[18]Anglesio MS, Kommoss S, Tolcher MC, et al. Molecular characterization of mucinous ovarian tumours supports a stratified treatment approach with HER2 targeting in 19% of carcinomas. J Pathol,2013,229(1):111-120.
[19]Hunter SM, Gorringe KL, Christie M, et al. Preinvasive ovarian mucinous tumors are characterized by CDKN2A and RAS pathway aberrations. Clin Cancer Res,2012,18(19):5267-5277.
[20]Atri M, Alabousi A, Reinhold C, et al. ACR Appropriateness Criteria clinically suspected adnexal mass, no acute symptoms. J Am Coll Radiol, 2019,16(5 Suppl):S77-S93.
[21]Jeong YY, Outwater EK, Kang HK. Imaging evaluation of ovarian masses. Radiographics,2000,20(5):1445-1470.
[22]Jung SE, Lee JM, Rha SE, et al. CT and MR imaging of ovarian tumors with emphasis on differential diagnosis. Radiographics,2002,22(6):1305-1325.
[23]Morice P, Gouy S, Leary A. Mucinous ovarian carcinoma. N Engl J Med,2019,380(13):1256-1266.
[24]Kelly PJ, Archbold P, Price JH, et al. Serum CA19.9 levels are commonly elevated in primary ovarian mucinous tumours but cannot be used to predict the histological subtype. J Clin Pathol,2010,63(2):169-173.
[25]董丽,崔恒,李小平,等.CA19-9、CA125和CP2在卵巢黏液性肿瘤诊断和监测中的价值.中华妇产科杂志,2008,43(1):5-8.
[26]Nolen B, Marrangoni A, Velikokhatnaya L, et al. A serum based analysis of ovarian epithelial tumorigenesis. Gynecol Oncol,2009,112(1):47-54.
[27]Ledermann JA, Luvero D, Shafer A, et al. Gynecologic Cancer InterGroup (GCIG) consensus review for mucinous ovarian carcinoma. Int J Gynecol Cancer,2014,24(9 Suppl 3):S14-S19.
[28]NCCN Clinical Practice Guidelines in Ovarian Cancer Including Fallopian Tube Cancer and Primary Peritoneal Cancer (Version 1.2021).［DB/OL］.https:∥wwwnccnorg/professionals/physician_gls/pdf/ovarian.pdf
[29]张师前,袁航.早期卵巢上皮性癌保留生育功能治疗.中国实用妇科与产科杂志,2019,35(6): 623-626.
[30]Bentivegna E, Fruscio R, Roussin S, et al. Longterm followup of patients with an isolated ovarian recurrence after conservative treatment of epithelial ovarian cancer: review of the results of an international multicenter study comprising 545 patients. Fertil Steril,2015,104(5):1319-1324.
[31]Lee JY, Jo YR, Kim TH, et al. Safety of fertilitysparing surgery in primary mucinous carcinoma of the ovary. Cancer Res Treat,2015,47(2):290-297.
[32]Kajiyama H, Shibata K, Mizuno M, et al. Fertilitysparing surgery in young women with mucinous adenocarcinoma of the ovary. Gynecol Oncol,2011,122(2):334-338.
[33]Gouy S, Saidani M, Maulard A, et al. Results of fertilitysparing surgery for expansile and infiltrative mucinous ovarian cancers. Oncologist,2018,23(3):324-327.
[34]Schmeler KM, Tao X, Frumovitz M, et al. Prevalence of lymph node metastasis in primary mucinous carcinoma of the ovary. Obstet Gynecol,2010,116(2 Pt 1):269-273.
[35]Heyward QD, Nasioudis D, Cory L, et al. Lymphadenectomy for earlystage mucinous ovarian carcinoma. Int J Gynecol Cancer,2020,31(1):104-109.
[36]Kleppe M, Wang T, Van Gorp T, et al. Lymph node metastasis in stages Ⅰ and Ⅱ ovarian cancer: a review. Gynecol Oncol,2011,123(3):610-614.
[37]Hoogendam JP, Vlek CA, Witteveen PO, et al. Surgical lymph node assessment in mucinous ovarian carcinoma staging: a systematic review and metaanalysis. BJOG,2017,124(3):370-378.
[38]Nasioudis D, ChapmanDavis E, Witkin SS, et al. Prognostic significance of lymphadenectomy and prevalence of lymph node metastasis in clinicallyapparent stage Ⅰ endometrioid and mucinous ovarian carcinoma. Gynecol Oncol,2017,144(2):414-419.
[39]Matsuo K, Machida H, Mariani A, et al. Adequate pelvic lymphadenectomy and survival of women with earlystage epithelial ovarian cancer. J Gynecol Oncol,2018,29(5):e69.
[40]Yoshihara M, Kajiyama H, Tamauchi S, et al. Prognostic impact of pelvic and paraaortic lymphadenectomy on clinicallyapparent stage Ⅰ primary mucinous epithelial ovarian carcinoma: a multiinstitutional study with propensity scoreweighted analysis. Jpn J Clin Oncol,2020,50(2):145-151.
[41]Rosendahl M, Haueberg Oester LA, Hgdall CK. The importance of appendectomy in surgery for mucinous adenocarcinoma of the ovary. Int J Gynecol Cancer,2017,27(3):430-436.
[42]Lin JE, Seo S, Kushner DM, et al. The role of appendectomy for mucinous ovarian neoplasms. Am J Obstet Gynecol,2013,208(1):46.e41-e44.
[43]Cheng A, Li M, Kanis MJ, et al. Is it necessary to perform routine appendectomy for mucinous ovarian neoplasms? A retrospective study and metaanalysis. Gynecol Oncol,2017,144(1):215-222.
[44]黄文倩,孔静仪,张师前.腹膜假黏液瘤诊治相关问题.中国实用妇科与产科杂志,2015,31(11):1008-1012.
[45]Baratti D, Kusamura S, Milione M, et al. Pseudomyxoma peritonei of extraappendiceal origin: A comparative study. Ann Surg Oncol,2016,23(13):4222-4230.
[46]Delhorme JB, Severac F, Averous G, et al. Cytoreductive surgery and hyperthermic intraperitoneal chemotherapy for pseudomyxoma peritonei of appendicular and extraappendicular origin. Br J Surg,2018,105(6):668-676.
[47]Alexandre J, RayCoquard I, Selle F, et al. Mucinous advanced epithelial ovarian carcinoma: clinical presentation and sensitivity to platinumpaclitaxelbased chemotherapy, the GINECO experience. Ann Oncol,2010,21(12):2377-2381.
[48]Karabuk E, Kose MF, Hizli D, et al. Comparison of advanced stage mucinous epithelial ovarian cancer and serous epithelial ovarian cancer with regard to chemosensitivity and survival outcome: a matched casecontrol study. J Gynecol Oncol,2013,24(2):160-166.
[49]Pisano C, Greggi S, Tambaro R, et al. Activity of chemotherapy in mucinous epithelial ovarian cancer: a retrospective study. Anticancer Res,2005,25(5):3501-3505.
[50]Du Bois A, Reuss A, PujadeLauraine E, et al. Role of surgical outcome as prognostic factor in advanced epithelial ovarian cancer: a combined exploratory analysis of 3 prospectively randomized phase 3 multicenter trials: by the Arbeitsgemeinschaft Gynaekologische Onkologie Studiengruppe Ovarialkarzinom (AGOOVAR) and the Groupe d’Investigateurs Nationaux Pour les Etudes des Cancers de l’Ovaire (GINECO). Cancer,2009,115(6):1234-1244.
[51]Simons M, Ezendam N, Bulten J, et al. Survival of patients with mucinous ovarian carcinoma and ovarian metastases: A populationbased cancer registry study. Int J Gynecol Cancer,2015,25(7):1208-1215.
[52]Nasioudis D, Haggerty AF, Giuntoli RL, 2nd, et al. Adjuvant chemotherapy is not associated with a survival benefit for patients with early stage mucinous ovarian carcinoma. Gynecol Oncol,2019,154(2):302-307.
[53]Winter WE, 3rd, Maxwell GL, Tian C, et al. Prognostic factors for stage Ⅲ epithelial ovarian cancer: a Gynecologic Oncology Group Study. J Clin Oncol,2007,25(24):3621-3627.
[54]Jain A, Ryan PD, Seiden MV. Metastatic mucinous ovarian cancer and treatment decisions based on histology and molecular markers rather than the primary location. J Natl Compr Canc Netw,2012,10(9):1076-1080.
[55]Kurnit KC, Sinno AK, Fellman BM, et al. Effects of gastrointestinaltype chemotherapy in women with ovarian mucinous carcinoma. Obstet Gynecol,2019,134(6):1253-1259.
[56]Gore M, Hackshaw A, Brady WE, et al. An international, phase Ⅲ randomized trial in patients with mucinous epithelial ovarian cancer (mEOC/GOG 0241) with longterm followup: and experience of conducting a clinical trial in a rare gynecological tumor. Gynecol Oncol,2019,153(3):541-548.
[57]Van Driel WJ, Koole SN, Sikorska K, et al. Hyperthermic intraperitoneal chemotherapy in ovarian cancer. N Engl J Med,2018,378(3):230-240.
[58]Wu Q, Wu Q, Xu J, et al. Efficacy of hyperthermic intraperitoneal chemotherapy in patients with epithelial ovarian cancer: a metaanalysis. Int J Hyperthermia,2019,36(1):562-572.
[59]Hotouras A, Desai D, Bhan C, et al. Heated intraperitoneal chemotherapy (HIPEC) for patients with recurrent ovarian cancer: A systematic literature review. Int J Gynecol Cancer,2016,26(4):661-670.
[60]Mercier F, Bakrin N, Bartlett DL, et al. Peritoneal carcinomatosis of rare ovarian origin treated by cytoreductive surgery and hyperthermic intraperitoneal chemotherapy: A multiinstitutional cohort from PSOGI and BIGRENAPE. Ann Surg Oncol,2018,25(6):1668-1675.
[61]李晶,林仲秋.妇科恶性肿瘤腹腔热灌注化疗临床应用专家共识(2019).中国实用妇科与产科杂志,2019,35(2):194-201.
[62]Gorringe KL, Cheasley D, Wakefield MJ, et al. Therapeutic options for mucinous ovarian carcinoma. Gynecol Oncol,2020,156(3):552-560.
[63]Hurwitz HI, Tebbutt NC, Kabbinavar F, et al. Efficacy and safety of bevacizumab in metastatic colorectal cancer: pooled analysis from seven randomized controlled trials.Oncologist,2013,18(9):1004-1012.
[64]Van Cutsem E, Khne CH, Hitre E, et al. Cetuximab and chemotherapy as initial treatment for metastatic colorectal cancer. N Engl J Med,2009,360(14):1408-1417.
[65]Sato N, Saga Y, Mizukami H, et al. Cetuximab inhibits the growth of mucinous ovarian carcinoma tumor cells lacking KRAS gene mutations. Oncol Rep,2012,27(5):1336-1340.
[66]Kim SK, Cho NH. HER2positive mucinous adenocarcinomas of the ovary have an expansile invasive pattern associated with a favorable prognosis. Int J Clin Exp Pathol,2014,7(7):4222-4230.
[67]Mcalpine JN, Wiegand KC, Vang R, et al. HER2 overexpression and amplification is present in a subset of ovarian mucinous carcinomas and can be targeted with trastuzumab therapy. BMC Cancer,2009,9:433.
[68]Kajiyama H, Mizuno M, Shibata K, et al. Extremely poor postrecurrence oncological outcome for patients with recurrent mucinous ovarian cancer. Int J Clin Oncol,2014,19(1):121-126.
[69]Pignata S, Ferrandina G, Scarfone G, et al. Activity of chemotherapy in mucinous ovarian cancer with a recurrence free interval of more than 6 months: results from the SOCRATES retrospective study. BMC Cancer,2008,8:252.
[70]Cheng X, Jiang R, Li ZT, et al. The role of secondary cytoreductive surgery for recurrent mucinous epithelial ovarian cancer (mEOC). Eur J Surg Oncol,2009,35(10):1105-1108.

更新日期/Last Update: 2021-10-11