Division of Gynecologic Oncology, Robert H. Lurie Comprehensive, Cancer Center, Northwestern University Feinberg School of Medicine, Chicago, IL, USA.
Gynecol Oncol. 2011 May 1;121(2):285-9. doi: 10.1016/j.ygyno.2011.01.003. Epub 2011 Jan 21.
The objective of this study is to review all malignant germ-cell tumors (MOGCTs) treated at our institution, focusing on reproductive outcomes and menstrual function of patients treated with fertility-sparing surgery and adjuvant chemotherapy.
We performed a retrospective chart review of patients treated for MOGCTs between January 1, 1979 and March 31, 2008. Charts of identified patients were abstracted and data were collected. Patients who had fertility-sparing surgery were contacted and a telephone questionnaire was performed to gather reproductive and menstrual history.
Forty patients were treated for MOGCTs at our institution. Mean age at the time of diagnosis was 26.5years (range, 10-48years). Histologic subtypes were: immature teratoma (52.5%), dysgerminoma (27.5%), yolk sac tumor (10.0%), mixed germ cell tumor (7.5%), and choriocarcinoma (2.5%). Thirty-five percent of tumors were FIGO stages II-IV. Twenty-seven patients (67.5%) were treated with chemotherapy postoperatively, 23 (85%) of whom received bleomycin, etoposide and cisplatin (BEP). There were three recurrences, but no deaths. Fertility-sparing surgery was performed in 22 patients (55%), 16 of whom received adjuvant chemotherapy. Fourteen of these patients were contacted. Of the 10 remaining patients desiring pregnancy, 8 (80%) had 11 successful spontaneous pregnancies, one required in-vitro fertilization, and the other required donor egg in-vitro fertilization, resulting in 14 live births. All 14 patients had normal menstrual cycles within one year of completing chemotherapy.
Overall survival was 100% among patients with both local and advanced MOGCTs, including those who underwent fertility-sparing surgery. Fertility-sparing surgery plus adjuvant chemotherapy appeared to have little or no effect on fertility or menstrual cycles.
本研究旨在回顾在我院治疗的所有恶性生殖细胞肿瘤（MOGCT）患者，重点关注接受保留生育功能手术和辅助化疗治疗的患者的生殖结局和月经功能。
我们对 1979 年 1 月 1 日至 2008 年 3 月 31 日期间在我院治疗的 MOGCT 患者进行了回顾性病历分析。提取了确定患者的病历并收集了数据。对接受保留生育功能手术的患者进行了联系，并通过电话问卷调查收集了生殖和月经史。
我院共治疗了 40 例 MOGCT 患者。诊断时的平均年龄为 26.5 岁（范围为 10-48 岁）。组织学亚型为：未成熟畸胎瘤（52.5%）、无性细胞瘤（27.5%）、卵黄囊瘤（10.0%）、混合生殖细胞肿瘤（7.5%）和绒毛膜癌（2.5%）。35%的肿瘤为 FIGO 分期 II-IV 期。27 例（67.5%）患者术后接受化疗，其中 23 例（85%）接受博来霉素、依托泊苷和顺铂（BEP）治疗。有 3 例复发，但无死亡。22 例（55%）患者接受保留生育功能手术，其中 16 例接受辅助化疗。对其中 14 例患者进行了联系。在 10 名希望怀孕的剩余患者中，8 名（80%）成功自然妊娠 11 次，1 名需要体外受精，另 1 名需要供卵体外受精，共 14 名活产。所有 14 名患者在完成化疗后一年内均恢复正常月经周期。
局部和晚期 MOGCT 患者（包括接受保留生育功能手术的患者）的总生存率为 100%。保留生育功能手术加辅助化疗似乎对生育能力或月经周期没有影响或影响很小。
