Primary fallopian tube cancer

　　One, etiology

　　The etiological factors of fallopian tube cancer have not been fully understood. Due to the fact that most patients are accompanied by chronic salpingitis, the rate of infertility is high, and there is often a history of acute salpingitis, chronic inflammatory cells are present in the fallopian tube specimen, it is inferred that chronic salpingitis may be related to the occurrence of fallopian tube cancer. However, chronic salpingitis is a relatively common gynecological disease, and there is no increase in the incidence of fallopian tube cancer in the population with a high incidence of salpingitis. After all, fallopian tube cancer is a rare malignant tumor, and during pathological examination, it is common to see chronic salpingitis on the affected side, while the other side shows no obvious inflammatory phenomenon, so it is also possible that the inflammatory changes in the fallopian tube are secondary to fallopian tube cancer. In addition, there are also reports of concurrent fallopian tube cancer and tuberculosis, fallopian tube cancer occurring after tubal ligation, etc., which may also be etiological factors for fallopian tube cancer.

　　Two, pathogenesis

　　The vast majority of primary fallopian tube cancer is papillary adenocarcinoma, accounting for 90%, with other tissue types including clear cell carcinoma, squamous cell carcinoma, adenoid cystic carcinoma, adenosquamous carcinoma, mucinous carcinoma, and endometrioid carcinoma, etc.

　　1. Gross morphology:Due to the different sizes and growth sites of the tumor, fallopian tube cancer shows different macroscopic appearances in the specimen. Overall, it presents with thickening, irregular shape, or spindle shape of the fallopian tube. In the early stage when the tumor is limited to the mucosal layer, only small nodular thickening of the fallopian tube can be seen during surgery, and soft nodules can be palpated. If the muscular layer is invaded, the hardness of the nodules or masses increases, and if the serosal layer is not invaded, the serosal surface is smooth. When the lumen is filled with tumor tissue, the fallopian tube can take on a sausage or sausagelike shape. The cross-section of the fallopian tube shows that the lumen is filled with cauliflower-like tissue, and sometimes necrotic masses can also be seen.

　　2. Histological typing:Hu, Taymor, and Hertig et al. divided the histological typing of fallopian tube cancer into three grades, which is the most commonly used tissue typing today.

　　Grade 1 papillary type (papillary), with the tumor confined to the mucosa and without muscular layer infiltration. The tumor protrudes into the lumen in a papillary shape. The papilla is covered by columnar cuboidal epithelium, arranged in a stratified manner, with irregular shape and loss of polarity. Nuclear staining is deep with mitotic figures. The transition zone between normal mucosa and cancer is often visible.

　　Grade 2 papillary acinar type (papillary alveolar), where the papillary structure still exists, but cell differentiation is poor, showing marked heterogeneity, and there is often the formation of small acini or acinar cavities, commonly accompanied by muscular layer infiltration of the fallopian tube.

　　Grade 3 medullary acinar type (medullary), with poor cell differentiation and numerous mitotic figures. Cells grow diffusely in sheets, and sometimes acinar structures can be seen, with obvious muscular layer infiltration.

　　These three types of tissue structures represent a gradually evolving process, with the papillary type often indicating an earlier stage of lesion with lower malignancy. The papillary acinar and medullary acinar types, on the other hand, are usually associated with a later stage and higher malignancy. Sometimes, all three types can be present simultaneously in the same specimen, and the dominant type should be determined accordingly.

　　Primary fallopian tube cancer is also occasionally reported, which is often found due to the removal of the fallopian tube for other reasons. The lesions are often small and localized, showing stratified hyperplasia of the mucosal epithelium with severe atypia, deeper nuclear staining, disordered cell arrangement, and frequent nuclear division. In situ cancer should be distinguished from reactive atypical hyperplasia, the former being focal and the latter often diffuse, with differences in nuclear morphology, nuclear staining, and nuclear division.

　　Various histological types of ovarian cancer can also be found in fallopian tube cancer, such as serous papillary carcinoma, mucinous adenocarcinoma, endometrioid carcinoma, transitional cell carcinoma, clear cell carcinoma, etc.

　　In addition to the above histological types, there are some less common types, such as squamous cell carcinoma, adenosquamous carcinoma, hyaline cell carcinoma, and交界性囊腺瘤, etc.

　　The most common site of fallopian tube cancer is the ampulla of the fallopian tube, followed by the fimbria, with bilateral cases accounting for 10% to 26%.

　　3, Histological diagnosis:The diagnosis of primary fallopian tube cancer should at least meet the following two criteria:

　　(1) The fallopian tube tumor is not connected with tumors in other parts.

　　(2) The histological appearance of the fallopian tube tumor is significantly different from that of tumors in other parts.

　　(3) The fallopian tube tumor is significantly larger or longer than tumors in other parts.

　　(4) The malignancy and stage of the fallopian tube tumor exceed those of tumors in other parts.

　　4, Staging and metastasis routes

　　(1) Staging: For the staging of fallopian tube cancer, there has been no unified staging standard in the world for a long time. As early as 1967, Zrez et al. and in 1971, Schiller and Silverberg et al. proposed that the fallopian tube is a hollow organ with endometrial and muscularis tissue, similar to the colon, and its infiltration and spread in tumor development is different from that of ovarian tumors, so it is suggested to refer to the Duke colorectal cancer staging system to formulate the staging of fallopian tube cancer (Table 1).

　　Due to the proximity of the fallopian tube to the ovary and the similarity of many biological behaviors, many scholars always refer to the clinical staging of ovarian cancer when staging fallopian tube cancer. In September 1991, the International Federation of Gynecology and Obstetrics (FIGO) officially recommended the staging method for fallopian tube cancer (Table 2), both of which are surgical staging methods.

　　(2) Metastasis routes: The metastasis routes of fallopian tube cancer are similar to those of ovarian cancer, usually with 3 metastasis routes.

　　①Direct spread: Fallopian tube cancer can spread to the peritoneum and ovary through the fimbria, or it can spread to the pelvic and abdominal cavity due to the penetration of the fallopian tube serosa. Another way is to spread to the uterine cavity, cervix, or even the contralateral fallopian tube through the peristalsis of the fallopian tube.

　　②Lymphatic metastasis: The fallopian tube and ovary share the same lymphatic drainage pathway. Pelvic lymph nodes and para-aortic lymph nodes are the main sites of lymphatic metastasis of fallopian tube cancer. Due to the rarity of fallopian tube cancer cases, and the lack of routine lymph node dissection during treatment, the exact lymph node metastasis rate is not clear. It is estimated that the total lymph node metastasis rate of fallopian tube cancer in all stages accounts for about half, and the para-aortic lymph node metastasis rate accounts for about 1/3. The lymph node metastasis rate found in autopsies is even higher. In addition, there are also a few reports of inguinal lymph node or supraclavicular lymph node metastasis. Cancer lesions that are small or localized can also occur lymph node metastasis.

　　③ Hematogenous metastasis: In the late stage of cancer, hematogenous metastasis can occur to the lungs, brain, liver, kidneys, and other organs.

　　The occurrence of complications is mainly related to the timing of disease discovery and treatment measures, which can lead to fallopian tube adhesion, inflammation infection, bleeding. Local metastasis and the trauma of surgery itself can cause adhesion of pelvic tissue; metastasis to the ovary can cause changes in ovarian function, leading to endocrine abnormalities; metastasis to the endometrium can cause non-menstrual bleeding; metastasis to the kidney and fallopian tube, bladder can cause hematuria, renal dysfunction; distant metastasis can cause liver metastasis cancer, lung metastasis cancer, etc.

　　Early fallopian tube cancer often has no symptoms. With the development of the lesion, the following symptoms and signs may occur:

　　1. Vaginal discharge:Cancer tissue grows in the fallopian tube, with a lot of exudation. In addition, the fimbria of the fallopian tube is often blocked and sealed, so it is excreted into the uterine cavity and discharged through the vagina, which is an important clinical symptom of fallopian tube cancer. More than 50% of patients have vaginal discharge, and the discharged fluid is mostly serous or serous blood. The amount is large, and there are reports of up to more than 1000ml. Sometimes, the discharged fluid also contains necrotic and shed tissue fragments. Lower abdominal colic occurs with intermittent vaginal discharge. After vaginal discharge, abdominal pain decreases, the fallopian tube mass shrinks or disappears, which is the manifestation of extravasation of hydrosalpinx. It is caused by the filling and emptying of the fallopian tube, which is partially obstructed by fallopian tube cancer. About 9% of patients have this symptom and are easily misdiagnosed as urogenital fistula.

　　2. Vaginal bleeding:Tumor necrosis or erosion of blood vessels can cause bleeding, but the amount of bleeding is not much. If mixed with secretory fluid, it appears as serous blood. Fallopian tube cancer is highly prevalent in the perimenopausal or postmenopausal period, and the vaginal bloody fluid at this time should be highly alert. Abnormal vaginal bleeding in fallopian tube cancer accounts for about 62%. If irregular vaginal bleeding occurs during the high-risk age and the curettage is negative, the possibility of fallopian tube cancer should be considered.

　　3. Abdominal pain:Fallopian tube mass can cause discomfort or hidden pain in the lower abdomen, and if the fallopian tube is twisted or there is extravasation of hydrosalpinx, severe pain or colic may occur. There are not many cases with severe abdominal pain, but about half of the patients have varying degrees of abdominal pain or discomfort.

　　4. Infertility:Since there are many cases with chronic salpingitis, primary or secondary infertility history is very common, but this is not a specific symptom.

　　5. Pelvic mass:The presence of adnexal mass is an important sign of fallopian tube cancer. Preoperative examination found that pelvic mass accounted for 61% to 65%, and larger masses can be felt by patients themselves.

　　6. Other symptoms:Due to the enlargement and development of the tumor, some symptoms of organ compression around the tumor and symptoms caused by tumor metastasis may occur, such as abdominal distension, frequent urination, urgency, gastrointestinal discomfort, and cachexia. The typical symptoms of fallopian tube cancer are 'triad syndrome', which includes abdominal pain, pelvic mass, and serous vaginal discharge. Another group of 'triad syndrome' proposed is vaginal bleeding, vaginal discharge, and lower abdominal pain. For those with pelvic mass accompanied by a large amount of vaginal discharge, it can also be called the 'bifid syndrome' of fallopian tube cancer. Those with triad or bifid syndrome should be paid attention to.

　　Due to the low incidence of fallopian tube cancer and the lack of specific and reliable diagnostic methods in clinical practice, it is often overlooked or misdiagnosed as ovarian tumor or other diseases before surgery. In 1898, Falk made a diagnosis by aspirating cancerous fluid from the posterior fornix, which was the first case in the world to be diagnosed preoperatively. Among the 71 cases reported by Eddy et al., only 2 were diagnosed preoperatively. With the increasing understanding of the disease, only 4.7% of preoperative diagnoses were reported in the literature. Most patients who were diagnosed preoperatively had a triad, biphase, or a very experienced doctor. Pelvic mass or large vaginal effusion are the most important symptoms of fallopian tube cancer, and when both are present, one should carefully exclude fallopian tube cancer.

　　1. Understanding the three major symptoms of fallopian tube cancer

　　1. Vaginal discharge or bleeding

　　This is a relatively special symptom of fallopian tube cancer. Patients may have a certain amount of serous yellow fluid discharged from the vagina every day, sometimes with bloodstains or pink in an intermittent manner, generally without an odor. When the cancer focus necrotizes or invades blood vessels, vaginal bleeding may occur.

　　2. Abdominal mass

　　Due to the enlargement of the tumor within the fallopian tube or the occurrence of hydrosalpinx, patients often feel a long, swollen fallopian tube during gynecological examination, with limited mobility or fixation.

　　3. Abdominal pain

　　It often occurs on the affected side, and due to obstruction of the fimbria, increased intraluminal pressure, and increased peristalsis, patients may experience dull pain in the lower abdomen, which gradually intensifies and becomes spasmodic colic. After the vaginal discharge of watery or bloody fluid, the pain usually subsides.

　　Many patients can have no symptoms in the early stage. In addition, some patients may have complications such as ascites, infertility, and weight loss, but these are not specific symptoms of fallopian tube cancer. The most important symptom to be alert for is vaginal discharge. If there is unexplained vaginal discharge, one should go to the hospital for examination immediately.

　　Second, prognosis

　　It was previously believed that fallopian tube cancer had a high degree of malignancy and poor prognosis, with a 5-year survival rate of less than 2% in early reports. However, with the improvement of diagnosis and treatment, the proportion of early cases detected has increased, and the prognosis of fallopian tube cancer has also improved. Peters et al. collected 115 cases treated between 1928 and 1987, with a 5-year survival rate of 61% in stage I, 29% in stage II, 17% in stage III, and 0 in recurrent cancer. Since the implementation of maximum resection and combined chemotherapy with cisplatin for advanced patients, the survival rate has further increased. In recent years, Muntz et al. reported a 5-year survival rate of 100% in stage I, 65% in stage II, 40% in stage III, and 25% in stage IV. Barakat reported that the 5-year survival rate for stage III and IV patients also reached 51%, indicating that the efficacy is continuously improving. With reasonable treatment, the prognosis of fallopian tube cancer can be significantly improved.

　　Factors affecting prognosis:

　　1. Clinical staging:As everyone knows, the earlier the stage, the better the efficacy and prognosis, and the worse the prognosis for advanced cases. Most reports show that there are almost no 5-year survivors in stage IV.

　　2. Residual tumor focus after the first surgery:The postoperative chemotherapy effect is better for residual tumors ≤2cm, and the 5-year survival rate is also relatively high. If there is a large amount of residual tumor, the prognosis is poor.

　　3. Depth of fallopian tube invasion:The prognosis is good for tumors that only invade the mucosal layer, while it is poor for tumors that penetrate the serous membrane layer. The prognosis is related to the depth of invasion of the fallopian tube wall. If the lesion is limited to the fallopian tube mucosa, the 5-year survival rate is 91%, and it decreases to 53% if the muscular layer is invaded. If the serous membrane layer is penetrated, the 5-year survival rate is less than 25%.

　　4. Pathological grading:There is no consensus on the relationship between pathological grading and prognosis reported in the literature. Some data suggest that high differentiation has a good prognosis while low differentiation has a poor prognosis. However, recent research cannot support the above views, as many tumors coexist with different pathological grades. The significance of pathological grading for prognosis is far less than that of clinical staging and other factors.

　　1. Cytology examination:The fallopian tube communicates with the uterine cavity, and the fluid inside the tube is excreted into the uterine cavity with the peristalsis of the fallopian tube, and it also contains shed cells. Therefore, the cytological examination of vaginal fluid can often detect fallopian tube cancer cells. The characteristics of shed cells in fallopian tube cancer are that the cells are spherical or papillary, the amount of malignant cells is rare, the cells degenerate, and there are no cell fragments in the background. The positive rate of cytology in fallopian tube cancer reported by various studies ranges from 0-18%, and there are also a few reports with a positive rate as high as 40-60%. Patients with positive cytology should undergo curettage to exclude endometrial cancer. If cytology is positive while curettage is negative, it is very possible to be fallopian tube cancer. When the tumor penetrates the serous membrane layer or has pelvic and abdominal diffusion, malignant cells may be found in the peritoneal fluid or lavage fluid.

　　2. Imaging examination:The commonly used imaging examinations include ultrasound, CT, MRI, etc. These examinations can suggest pelvic masses and distinguish between cystic or solid masses, and are essential means for the diagnosis of fallopian tube cancer. Of course, it is not necessary to perform all three examinations, one or two can be chosen. If the fallopian tube cancer focus is very small (

　　3. Serum CA125 measurement:CA125 exists in mesothelial tissue, Mullerian epithelium, and tumors derived from it, such as ovarian cancer, fallopian tube cancer, endometrial cancer, and mesothelioma. Elevated CA125 levels can be detected in these cancers, and Niloff et al. and Lootsma-Miklosova et al. have reported elevated CA125 levels in fallopian tube cancer. In continuous monitoring, preoperative CA125 levels can reach as high as 145-535U/ml, and after initial treatment, they drop to 5U/ml. In two cases of recurrence, CA125 levels increase again. Therefore, the determination of CA125 can be an important reference index for the diagnosis, efficacy, and prognosis observation of fallopian tube cancer. Raised found that elevated CA125 levels (30U/ml) appeared 3-11 months earlier than clinical symptoms, and the determination of CA125 is conducive to early diagnosis.

　　4. Endoscopic examination:Hysteroscopy and laparoscopy can be used as preoperative examinations for suspected fallopian tube cancer. Finikiotis et al. have described yellow plaques located on the posterior wall of the uterus under hysteroscopy, which were later confirmed to be fallopian tube cancer. They believe that this may be a characteristic of fallopian tube cancer in the uterus. Special attention should be paid to the fimbria opening during hysteroscopy, and the fluid inside the fallopian tube should be aspirated for cytological examination. Biopsy of suspicious areas is beneficial for early diagnosis. Laparoscopy can directly observe the changes in the fallopian tube and ovary, which is helpful for diagnosis, and can also aspirate abdominal fluid for cytological examination.

　　5. Endometrial examination:Patients with endometrial cancer and submucosal fibroids of the uterus often have vaginal discharge. To exclude the above diseases, curettage is required to explore the uterine condition. However, curettage in fallopian tube cancer is often negative, except for those with intrauterine metastasis.

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　　1. Treatment

　　1. Surgical treatment:Surgery is the main method of treatment for fallopian tube cancer. Due to the rarity of fallopian tube cancer cases, there is no prospective study on treatment to date. The surgical methods and scope of fallopian tube cancer are mostly referred to ovarian cancer. Factors such as the extent of the patient's lesions, staging, age, and the requirement for fertility should be comprehensively considered. The operation should be carefully staged, carefully explore the pelvis and abdominal cavity, and perform a cytological examination of abdominal fluid or lavage fluid. It should also be explored at the diaphragm, liver, spleen, and gastrointestinal tract. Since cancer cells are prone to fall off from the fimbria or serosal surface into the peritoneal cavity, the cytological examination of abdominal fluid or lavage fluid is very important. The scope of the initial surgical treatment should include total hysterectomy, bilateral salpingo-oophorectomy, and omentectomy. For those who are very young, have an extremely early stage, and have not given birth, it should be handled differently. The preservation of fertility is limited to a few extremely early patients. The risk of recurrence should also be fully considered.

　　Peter and Gurney, among others, have reported that the size of residual tumor after surgery is significantly related to prognosis. If the residual tumor can be reduced to less than 2 cm in diameter or even no visible residual tumor, the 5-year survival rate can be greatly improved. Barakat et al. treated patients with stages II, III, and IV, and the 5-year survival rate of patients without residual tumor after surgery was 83%, while those with residual tumor lesions were only 28%. Therefore, it is necessary to reduce the residual tumor to the minimum extent possible during surgery, and it is best to have no residual tumor lesion.

　　Tamimi reported that 53% of 15 cases of tubal cancer had lymph node metastasis, with 5 cases of positive para-aortic lymph nodes, among which 2 cases had only para-aortic lymph node metastasis without metastasis elsewhere. Schray reported that 34 cases had 34% of retroperitoneal lymph node metastasis. Now, more and more physicians advocate for the performance of pelvic and para-aortic lymph node dissection for the treatment of tubal cancer, which is also the need for surgical staging.

　　The significance of performing a second exploration after the initial operation and a certain course of chemotherapy is not yet completely clear. Theoretically, it should be similar to the second exploration of ovarian cancer, which has certain reference value for indicating the efficacy of treatment and deciding whether to terminate treatment. Recent literature shows that among patients with tubal cancer who are confirmed to be pathologically complete remission by second exploration, a portion of cases still recur later. The recurrence rate of primary tumor stage I is 22%, and the recurrence rate of stages III and IV is higher, reaching 50%. The second exploration cannot reduce recurrence and metastasis. The recurrence rate is lower for patients with early primary tumors or those who have received platinum-based combination chemotherapy. The recurrence rate is lower after a negative second exploration.

　　2. Chemotherapy:Similar to ovarian cancer, for middle and advanced stage patients, chemotherapy is often used as the main adjuvant treatment after surgery. Due to the limited number of cases of tubal cancer, most of which are scattered reports, there is a lack of chemotherapy experience from large-scale cases. The chemotherapy drugs used in the early literature for tubal cancer include busulfan (Myleran), mechlorethamine, cyclophosphamide, thiotepa, and so on. Later, doxorubicin (adriamycin) and cisplatin were also used. The efficacy of single drug use is not high, and the remission time is also short. In the past 20 years, the use of cisplatin and combination chemotherapy based on cisplatin has gradually increased, and the overall efficacy of combination chemotherapy containing cisplatin has reached 67% to 80%. It can also extend the survival time of advanced patients. The combination chemotherapy regimen is similar to that of ovarian cancer chemotherapy, and the most commonly used is the combination of cisplatin and cyclophosphamide (CP regimen) or doxorubicin (adriamycin) in combination or the combination of the three drugs (CAP regimen). The efficacy of CAP combined chemotherapy in treating all stages of tubal cancer is definite. The 5-year survival rate after treatment is 73% for stage I, 25% for stage II, and 19% for stage III. The toxic and side effects are acceptable. Due to the use of the cisplatin-based regimen, the survival rate of patients with tubal cancer has increased nearly fourfold. It is now considered that all patients with stages II, III, and IV, and some high-risk stage I patients (such as tumors infiltrating beyond the mucosal layer, poorly differentiated cancer, etc.), should be treated with combination chemotherapy containing cisplatin. More case studies have shown that the survival rate of patients with tubal cancer who receive chemotherapy after surgery is better than those who do not receive chemotherapy. Combination chemotherapy containing cisplatin is better than that without cisplatin.

　　Recently, the Memorial Sloan-Kettering Cancer Center in New York, USA, summarized the treatment experience of 24 cases of primary fallopian tube cancer with paclitaxel-based combined chemotherapy. The dose of paclitaxel was 135-175mg/m2, combined with cisplatin or carboplatin. The 1-year survival rate after treatment was 96%, the 3-year survival rate was 90%, and the overall progression-free survival was 27 months. The 3-year progression-free survival rate after satisfactory debulking surgery was 67%, while the 3-year progression-free survival rate after unsatisfactory debulking surgery was 45%. This treatment plan is significantly better than other plans, and the recurrence rate after satisfactory debulking surgery is lower. Paclitaxel chemotherapy can achieve a higher survival rate for fallopian tube cancer patients, especially after satisfactory debulking surgery.

　　There have been reports of treating fallopian tube cancer patients who are resistant to cisplatin and have recurred with high-dose paclitaxel, resulting in the complete disappearance of recurrent pelvic masses and achieving clinical complete remission. The dose used was 200mg/m2, administered intravenously for 24 hours, combined with granulocyte colony-stimulating factor support therapy, repeated every 3 weeks for a total of 5 courses. Paclitaxel can be used as a first-line chemotherapy drug for fallopian tube cancer or as a second-line chemotherapy drug after resistance to cisplatin.

　　There have been cases of treating fallopian tube cancer with medroxyprogesterone acetate (medroxyprogesterone) or megestrol acetate (megesterol), which is mainly limited to early stages and used in combination with alkylating agents, but it does not significantly improve efficacy or prevent recurrence. The therapeutic effect of hormones on fallopian tube cancer has not been confirmed.

　　3. Radiotherapy:The efficacy of radiotherapy for fallopian tube cancer is still controversial. Some advocate postoperative radiotherapy, while others believe that radiotherapy does not improve the efficacy. Since fallopian tube cancer is rarely diagnosed before surgery, radiotherapy is mainly used postoperatively. There is no unified staging in the reports, and surgery lacks unified standards. In addition, the differences in radiation sources, irradiation fields, irradiation doses, and fractionation make it difficult to evaluate the actual efficacy of radiotherapy. Several randomized studies have compared the efficacy of surgery alone with that of surgery combined with postoperative radiotherapy, showing that the addition of radiotherapy is beneficial for prolonging survival, even if the lesions are limited to the fallopian tube (stage I) or within the pelvis (stage II). Pelvic radiotherapy combined with whole abdominal radiotherapy can achieve the best results, because even in early stages, malignant cells are more likely to spread into the peritoneal cavity. In addition, high-energy radiotherapy (mega-voltage) is superior to X-ray therapy (orthovoltage), and the pelvic dose should be at least 50Gy.

　　There are reports on the treatment of fallopian tube cancer with intraperitoneal injection of radioactive nuclides. The existing data do not support the use of radioactive nuclides for treatment, and larger residual tumors are more difficult to produce efficacy.

　　Second, prognosis

　　It was previously believed that fallopian tube cancer had a high degree of malignancy and poor prognosis, and the 5-year survival rate was not enough to reach 2% in early reports. However, due to the improvement of diagnosis and treatment levels, the proportion of early cases found has increased, so the prognosis of fallopian tube cancer has also improved. Peters et al. collected 115 cases treated from 1928 to 1987, with a 5-year survival rate of 61% for stage I, 29% for stage II, 17% for stage III, and 0 for recurrent cancer. Since the maximum debulking surgery for advanced patients and the use of combination chemotherapy containing cisplatin have been carried out, the survival rate has further increased. In recent years, Muntz et al. reported a 5-year survival rate of 100% for stage I, 65% for stage II, 40% for stage III, and 25% for stage IV. Barakat reported that the 5-year survival rate of stage III and IV patients also reached 51%, indicating that the efficacy is continuously improving, and fallopian tube cancer can significantly improve prognosis with reasonable treatment.

　　Factors affecting prognosis:

　　1. Clinical staging:As everyone knows, the earlier the stage, the better the efficacy and prognosis. Conversely, the prognosis of late-stage patients is poor. Most reports show that there are almost no 5-year survivors in stage IV.

　　2. Residual tumor focus after the first surgery:The postoperative chemotherapy effect is better for residual tumors ≤2cm, and the 5-year survival rate is also relatively high. If there is a large amount of residual tumor, the prognosis is poor.

　　3. Depth of fallopian tube invasion:The prognosis is good for tumors that only invade the mucosal layer, but poor for those that penetrate the serosal layer. The prognosis is related to the depth of invasion of the fallopian tube wall. If the lesion is limited to the mucosal layer of the fallopian tube, the 5-year survival rate is 91%, and it decreases to 53% if the muscle layer is invaded. If the serosal layer is penetrated, the 5-year survival rate is less than 25%.

　　4. Pathological grading:Literature reports on the relationship between pathological grading and prognosis are not consistent. Some data suggest that high differentiation has a good prognosis while low differentiation has a poor prognosis, but recent research does not support the above view. Many tumors have different pathological grades at the same time, and the significance of pathological grading for prognosis is far less than that of clinical staging and other factors.