卵巢恶性生殖细胞肿瘤保守性手术及化疗后的生殖功能

Reproductive function after conservative surgery and chemotherapy for malignant germ cell tumors of the ovary.

作者信息

Tangir Jacob, Zelterman Daniel, Ma Wenging, Schwartz Peter E

机构信息

Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Yale University School of Medicine, New Haven, Connecticut 06520-8063, USA.

出版信息

Obstet Gynecol. 2003 Feb;101(2):251-7. doi: 10.1016/s0029-7844(02)02508-5.

DOI:10.1016/s0029-7844(02)02508-5

PMID:12576247

Abstract

OBJECTIVE

To analyze the long-term effects on reproductive function of fertility-preserving treatment for malignant germ cell tumors of the ovary.

METHODS

A case series analysis was performed on patients with malignant germ cell tumors of the ovary seen or consulted on at our institution between 1975 and 1995. Follow-up information regarding reproductive function was obtained by a mailed or telephone questionnaire.

RESULTS

A total of 106 patients with malignant germ cell tumors of the ovary were included in the study. Twenty patients were excluded because of loss of follow-up or death. For the remaining 86 patients, the median follow-up was 122 months (24-384 months). Fertility-preserving surgery was performed in 64 patients. Thirty-eight have attempted conception and 29 have achieved at least one pregnancy (76%). Among the patients who conceived, 20 were International Federation of Gynecology and Obstetrics (FIGO) stage I, one was stage II, and eight were stage III. Sixteen received vincristine, actinomycin D, and cyclophosphamide; three received cisplatin, vinblastine, and bleomycin; three received bleomycin, etoposide, and cisplatin; one received etoposide and cisplatin; four did not receive any chemotherapy; and two were treated with other combinations. Among the nine patients who could not conceive, seven were FIGO stage I and two were stage III. Four of these patients received vincristine, actinomycin D, and cyclophosphamide; three received etoposide and cisplatin; one received cisplatin, vinblastine, and bleomycin; and one patient received no chemotherapy. A total of 38 children were born to these women. Follow-up was available for 16 of these children, who have no evidence of congenital anomalies.

CONCLUSION

Fertility-preserving surgery followed by chemotherapy, even in advanced-stage malignant germ cell tumors of the ovary, is effective in conserving the reproductive function of women with malignant germ cell tumors of the ovary.

摘要

目的

分析卵巢恶性生殖细胞肿瘤保留生育功能治疗对生殖功能的长期影响。

方法

对1975年至1995年间在本机构就诊或咨询的卵巢恶性生殖细胞肿瘤患者进行病例系列分析。通过邮寄或电话问卷调查获取有关生殖功能的随访信息。

结果

本研究共纳入106例卵巢恶性生殖细胞肿瘤患者。20例因失访或死亡被排除。其余86例患者的中位随访时间为122个月（24 - 384个月）。64例患者接受了保留生育功能手术。38例尝试受孕，29例至少成功妊娠一次（76%）。在受孕的患者中，20例为国际妇产科联盟（FIGO）Ⅰ期，1例为Ⅱ期，8例为Ⅲ期。16例接受长春新碱、放线菌素D和环磷酰胺治疗；3例接受顺铂、长春花碱和博来霉素治疗；3例接受博来霉素、依托泊苷和顺铂治疗；1例接受依托泊苷和顺铂治疗；4例未接受任何化疗；2例接受其他联合治疗。在9例未受孕的患者中，7例为FIGOⅠ期，2例为Ⅲ期。这些患者中，4例接受长春新碱、放线菌素D和环磷酰胺治疗；3例接受依托泊苷和顺铂治疗；1例接受顺铂、长春花碱和博来霉素治疗；1例未接受化疗。这些女性共生育了38名儿童。对其中16名儿童进行了随访，未发现先天性异常迹象。