[Clinicopathological study of SET subtype of ovarian high-grade serous carcinoma].

Objective: To investigate the clinicopathological characteristics and significance of solid, endometrioid and transitional (SET) ovarian high-grade serous carcinoma (HGSC). Methods: A total of 408 cases of ovarian HGSC admitted to Peking University People's Hospital from January 2011 to September 2016 were collected. (1) According to the proportion of tumors with SET form in all tumors, they were divided into three groups: HGSC-classic group (<25%), HGSC-SET Ⅰ (25%-50%) and HGSC-SET Ⅱ (>50%) group. The clinical and pathological characteristics of three groups of ovarian HGSC patients were compared respectively. (2) According to the growth pattern, that was, the proportion of pushing/expanding invasive tumors in the whole pelvic disseminated tumors of pelvic disseminated tumors, the three groups were divided into four subgroups: group A (0-25%), group B (26%-50%), group C (51%-75%) and group D (>75%). Differences in progression-free survival (PFS) among the four subgroups in each group were compared respectively. Results: The median age of 408 cases with ovarian HGSC was 63.3 years (47-78 years), including 152 cases premenopausal and 256 cases postmenopausal. Among 408 cases of ovarian HGSC, 290 cases were in HGSC-classic group, 91 cases in HGSC-SET Ⅰ and 27 cases in HGSC-SET Ⅱ group. (1) There were significant differences in age, proportion of menopausal patients, tumor necrosis (including map necrosis or acne necrosis), response rate to primary chemotherapy, 5-year mortality rate and PFS between HGSC-SET Ⅰ and HGSC-SET Ⅱ (P<0.05). There was no significant difference among the above indexes between HGSC-SET Ⅰ and HGSC-SET Ⅱ (P>0.05). In HGSC-classic group, HGSC-SET Ⅰ and HGSC-SET Ⅱ, the proportion of family members or patients with history of epithelial ovarian cancer or breast cancer increased in turn, and the detection rate of serous tutal intraepithelial carcinoma (STIC) in fallopian tube tissue decreased in turn. There were significant differences between the two groups (P<0.05). (2) In HGSC-classic group, there were 147 cases in group A, 124 cases in group B and 19 cases in group C (0 case in group D), with median PFS of 17.4, 17.7 and 16.5 months respectively (P<0.05); 10, 6, 29 and 46 cases in group A, B, C and D in HGSC-SET Ⅰ, with median PFS of 9.6, 12.7, 30.1 months and 39.0 months respectively, which there were significant difference among group A and C and D (all P<0.05); among group B, C and D group in HGSC-SET Ⅱ, there were respectively 3, 12 and 12 cases (0 case in group A), and the median PFS was 13.5, 34.2 and 47.8 months (P<0.05). PFS was positively correlated with the increase of push/expansive infiltration ratio. Conclusions: The detection rate of STIC in ovarian HGSC patients with SET is higher, the effect of primary chemotherapy is better, and PFS is prolonged. PFS was significantly prolonged in patients with pelvic disseminated tumors of HGSC-SET, the infiltration of which were predominated by pushing or expanding boarder.目的： 探讨具有实性、内膜样、移行细胞样（SET）形态的卵巢高级别浆液性癌（HGSC）的临床病理特点及意义。 方法： 收集2011年1月—2016年9月在北京大学人民医院收治的卵巢HGSC共408例。分组：（1）根据具有SET形态的肿瘤占全部肿瘤的比例（SET所占比例）分为3组，SET所占比例<25%者为典型的HGSC（HGSC-classic）组、25%~50%者为HGSC-SETⅠ组、>50%者为HGSC-SETⅡ组，对3组卵巢HGSC患者的不同临床病理特点进行比较。（2）进一步根据盆腔播散性肿瘤的生长方式（分为侵袭性浸润、推挤性或膨胀性浸润两种），即根据推挤性或膨胀性浸润的肿瘤占整个盆腔播散性肿瘤的比例将上述3组均分为4个亚组，该比例占0~25%者为A组、26%~50%者为B组、51%~75%者为C组、>75%者为D组，分析3组卵巢HGSC患者各组中4个亚组间无进展生存时间（PFS）的差异。 结果： 408例卵巢HGSC患者的中位年龄为63.3岁（47~78岁），其中绝经前152例、绝经后256例。408例卵巢HGSC患者中，HGSC-classic组290例，HGSC-SETⅠ组91例，HGSC-SETⅡ组27例。（1）HGSC-SETⅠ组和HGSC-SETⅡ组患者的年龄、已绝经患者比例、肿瘤坏死（包括地图状坏死或粉刺状坏死）率、初次化疗反应率、5年死亡率和PFS分别与HGSC-classic组比较，差异均有统计学意义（P<0.05）；但HGSC-SETⅠ组与HGSC-SETⅡ组间上述指标分别比较，差异则均无统计学意义（P>0.05）。HGSC-classic组、HGSC-SETⅠ组和HGSC-SETⅡ组患者的家族中或患者本人有卵巢上皮性癌或乳腺癌病史的比例依次递增，输卵管组织中浆液性输卵管上皮内癌（STIC）的检出率依次递减，分别两两组间比较，差异均有统计学意义（P<0.05）。（2）HGSC-classic组（290例）患者中，A、B、C组分别为147、124、19例（D组为0例），其中位PFS分别为17.4、17.7、16.5个月，A组、B组分别与C组比较，差异均有统计学意义（P<0.05）。HGSC-SETⅠ组（91例）患者中，A、B、C、D组分别为10、6、29、46例，其中位PFS分别为9.6、12.7、30.1、39.0个月，A组分别与C组、D组比较，差异均有统计学意义（P<0.05）。HGSC-SETⅡ组（27例）患者中，B、C、D组分别为3、12、12例（A组为0例），其中位PFS分别为13.5、34.2、47.8个月，B组分别与C组、D组比较，差异均有统计学意义（P<0.05）。HGSC-classic组患者中，A+B组患者占93.4%（271/290），其盆腔播散性肿瘤的生长方式以侵袭性浸润为主；HGSC-SETⅠ组、HGSC-SETⅡ组患者中，C+D组患者分别占82.4%（75/91）、88.9%（24/27），其盆腔播散性肿瘤的生长方式均以推挤性或膨胀性浸润为主。 结论： 具有SET形态的卵巢HGSC患者的STIC检出率高、初次化疗效果好、PFS延长。HGSC-SET患者的盆腔播散性肿瘤主要以推挤性或膨胀性浸润的方式生长，其PFS明显延长。.