未被诊断而死亡:尼日利亚西北部资源贫乏地区卵巢肿瘤管理面临的挑战》。

Aisha Mustapha, Bashir Abubakar, Anisah Yahya, Oiza Tessy Ahmadu, Nafisa Bello, Ahmed Sa'ad, Adekunle Olanrewaju Oguntayo
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引用次数: 0

摘要

背景:卵巢癌是我院发病率第二高但致死率最高的妇科恶性肿瘤。本研究旨在确定疑似病变的未确诊率,并回顾我院高度怀疑为恶性的卵巢肿瘤的管理挑战:对病房、门诊、手术室和组织病理学实验室的患者病历进行了为期三年的回顾性分析。高度怀疑卵巢癌的病例(具有恶性放射学特征的卵巢肿瘤,同时伴有腹水、胸腔积液、恶病质、贫血或转移证据)被纳入其中。在妇科肿瘤多学科小组会议上,与放射科、肿瘤放射科、病理科和妇科肿瘤科各一名顾问进行了深入访谈:122例高度可疑卵巢恶性肿瘤患者的平均年龄为40.6岁。其中 28 例(23%)进行了手术,77% 没有任何形式的组织学诊断。在接受手术的患者中,13 例(46.4%)接受了前期手术,15 例(53.6%)接受了新辅助化疗(NACT),然后进行了间歇性剥除手术(IDS)。只有两个病例记录了完全(R0)切除。在接受前期手术的病例中,一例(7.7%)为卵巢纤维瘤,一例(7.7%)为纤维肉瘤,两例(15.4%)为边缘性卵巢肿瘤。有三例化疗是根据腹水或胸腔积液细胞学检查中的恶性细胞而开始的。在所有恶性病例中,上皮癌最为常见,占 48%。除了病例一般较晚出现外,治疗资金不足、癌症医疗保险覆盖率低、无法进行常规免疫组化、缺乏种系和体细胞检测、无法获得某些化疗药物或化疗费用过高、无法获得维持疗法、处理毒性反应的能力不足、所有专科的技能不足、无法获得计算机断层扫描或其功能不稳定、无法获得正电子发射断层扫描、缺乏介入放射设施等,都被认为是治疗面临的挑战。结论大多数肿瘤高度可疑为卵巢癌的患者没有得到组织学诊断,很可能在未确诊的情况下死亡。尽管在手术和化疗方面取得了进步,但卵巢癌的治疗仍然是一项挑战。建议为所有人提供医疗保险,发展基础设施,并对所有相关学科进行培训。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
Dying Undiagnosed: Challenges of Management of Ovarian Tumours in a Resource-Poor Setting in North-western Nigeria.

Background: Ovarian cancer is the second most prevalent but most lethal gynaecologic malignancy in our institution. This study aimed at determining the rate of non-diagnosis in suspected lesions and reviewing the management challenges of ovarian tumours highly suspicious for malignancy in our hospital.

Methodology: A three-year retrospective review of patients' records from the ward, clinic, theatre, and histopathology laboratory was carried out. Cases with high indices of suspicion for ovarian cancer (ovarian tumour with malignant radiologic features with any of ascites, pleural effusion, as well as cachexia, anaemia, or evidence of metastasis) were included. In-depth interviews were carried out with a consultant from each specialty of Radiology, Radio-oncology, Pathology, and Gynaecologic oncology at the gynaecologic oncology multidisciplinary team meeting.

Results: One hundred and twenty-two cases of highly suspicious ovarian malignancies were seen with a mean age of 40.6 years. Of these, 28 (23%) had surgery and 77% did not have any form of histological diagnosis. Of those that had surgery, 13 (46.4%) had upfront surgery and 15 (53.6%) neoadjuvant chemotherapy (NACT) followed by interval debulking surgery (IDS). Only two cases had documented complete (R0) debulking. Among those that had upfront surgery, one case (7.7%) was an ovarian fibroid and one (7.7%) was a fibrosarcoma while two cases (15.4%) were borderline ovarian tumours. Chemotherapy was commenced based on malignant cells on ascitic or pleural fluid cytology in three cases. Of all the malignant cases, epithelial carcinomas were commonest accounting for 48%. Aside from the general late presentation of cases, insufficient funds for treatment, poor coverage of health insurance for cancer care, unavailability of routine immunohistochemistry, lack of germline and somatic testing, non-availability or prohibitive cost of some chemotherapeutic agents, unavailability of maintenance therapies, inadequate capacity to manage toxicities, inadequate skill across all specialties, unavailability / erratic function of computerized tomography scans and unavailable positron emission tomography, lack of interventional radiology facility amongst others were all identified as challenges to management.

Conclusion: Most patients with tumours highly suspicious for ovarian cancers did not get a histologic diagnosis and probably died undiagnosed. Management of ovarian cancer remains a challenge despite advances in surgical and chemotherapeutic options. Health insurance for all, infrastructure development, and training of all disciplines involved is recommended.

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