Ⅰ期单纯未成熟卵巢畸胎瘤（IT）是否需要辅助化疗？一项卵巢癌的多中心意大利研究（MITO-9）。

Is adjuvant chemotherapy indicated in stage I pure immature ovarian teratoma (IT)? A multicentre Italian trial in ovarian cancer (MITO-9).

机构信息

Gynecology Department, IRCCS San Raffaele Hospital, Milan, Italy.

出版信息

Gynecol Oncol. 2010 Oct;119(1):48-52. doi: 10.1016/j.ygyno.2010.05.035.

DOI:10.1016/j.ygyno.2010.05.035

PMID:20599258

Abstract

OBJECTIVE

Conservative surgery followed by platinum-based chemotherapy is considered the standard approach for stage I immature ovarian teratoma (IT), except for stage IA G1. Nevertheless the use of chemotherapy in stage IA G2-3 and IB-IC is controversial. The aim of this study was to evaluate the outcome of patients with IT in order to define the role of chemotherapy in stage I disease.

METHODS

Twenty-eight patients with stage I IT treated in MITO centers were retrospectively reviewed. Grade, stage, age, surgical and postoperative treatment were analyzed using χ(2) test and T test looking for association with recurrence.

RESULTS

Median age was 25.5. Twenty-four patients underwent fertility-sparing surgery. FIGO stages were 19 IA, 2 IB, and 7 IC. Nine patients had grade 1 tumor, 12 grade 2, and 7 grade 3. Nine patients received adjuvant chemotherapy. Overall recurrence rate was 21.4% (2 in chemotherapy group and 4 in the group without treatment). No patients with G1 had recurrence, whereas 25% of G2 and 42.9% of G3 relapsed. Recurrence rate was not significantly different according to stage, grade or adjuvant chemotherapy, whereas it was greater in the group not operated in a MITO center, not staged and of age lower than 20 years, with statistical significance. At recurrence 4 patients presenting with mature teratoma were treated with surgery alone, whereas 2 recurring with IT were treated with surgery plus chemotherapy. After a median follow-up of 59 months all patients are NED.

CONCLUSIONS

Our study suggests that chemotherapy may be withheld for primary therapy and utilized only for recurrence.

摘要

目的

对于 I 期未成熟性卵巢畸胎瘤（IT），除了 IA G1 期外，保守性手术加铂类为基础的化疗被认为是标准治疗方法。然而，IA G2-3 和 IB-IC 期使用化疗仍存在争议。本研究旨在评估 IT 患者的预后，以确定化疗在 I 期疾病中的作用。

方法

回顾性分析在 MITO 中心治疗的 28 例 I 期 IT 患者。使用 χ(2)检验和 T 检验分析分级、分期、年龄、手术和术后治疗与复发的关系。

结果

中位年龄为 25.5 岁。24 例患者接受了保留生育功能的手术。FIGO 分期为 19 例 IA、2 例 IB 和 7 例 IC。9 例患者肿瘤分级为 1 级，12 例为 2 级，7 例为 3 级。9 例患者接受了辅助化疗。总复发率为 21.4%（化疗组 2 例，未治疗组 4 例）。G1 患者无一例复发，G2 患者复发率为 25%，G3 患者复发率为 42.9%。分期、分级或辅助化疗与复发率无显著相关性，但在未在 MITO 中心手术、未分期和年龄小于 20 岁的患者中，复发率显著增加，具有统计学意义。复发时，4 例表现为成熟畸胎瘤的患者仅接受手术治疗，而 2 例复发为 IT 的患者接受了手术加化疗。中位随访 59 个月后，所有患者均无疾病进展。