Gynecology Department, I.R.C.C.S. San Raffaele Hospital, Milan, Italy.
Gynecol Oncol. 2011 May 1;121(2):280-4. doi: 10.1016/j.ygyno.2011.01.006. Epub 2011 Jan 28.
Conservative surgery followed by platinum-based chemotherapy is considered the standard approach for pure ovarian dysgerminoma (POD), except for correctly staged IA patients. The aim of study was to evaluate the outcome of IA POD patients with incomplete surgical staging in order to define the proper management.
Data concerning primary treatment and recurrence were reviewed for 26 patients with stage IA POD treated in MITO (Multicenter Italian Trials in Ovarian Cancer) centers.
Median age was 22.5years. Primary surgery was fertility sparing for 17 patients (65.4%) and radical surgery was performed in 9 patients due to older age or gonadal dysgenesis. Only five patients (19.2%) had complete surgical staging; 38.5% had lymph node dissection, 46.2% had peritoneal biopsies and/or omentectomy and 65.4% had peritoneal washing. Seven patients received adjuvant chemotherapy. Overall recurrence rate was 11.5%: all recurrences occurred in the group submitted to incomplete staging procedure. No patients treated with adjuvant chemotherapy relapsed. One patient had pelvic recurrence, one patient relapsed in the abdomino-pelvic peritoneum and lymph nodes and the third patient showed a peritoneum, lymph nodal and residual ovary relapse. All patients with recurrence were cured by salvage therapy: 2 patients were treated with surgery plus chemotherapy and one only with chemotherapy. After a median follow-up of 100months all patients are alive without evidence of disease. Six patients opted for conception and delivered healthy infants, two with IVF with donor oocyte.
IA POD prognosis is excellent. Conservative surgery with a complete surgical staging is the gold standard. Patients with incomplete staging could undergo surgical restaging or surveillance. Chemotherapy should be reserved to relapse with excellent chances of therapeutic success.
对于纯卵巢生殖细胞瘤（POD），除了正确分期的 IA 期患者外，保守手术联合铂类化疗被认为是标准治疗方法。本研究旨在评估 IA 期 POD 患者不完全手术分期的结果，以确定合适的治疗方法。
回顾了在 MITO（多中心意大利卵巢癌临床试验）中心接受治疗的 26 例 IA 期 POD 患者的初始治疗和复发数据。
中位年龄为 22.5 岁。17 例患者（65.4%）行保留生育功能的初始手术，9 例患者因年龄较大或性腺发育不全而行根治性手术。仅有 5 例患者（19.2%）行完全手术分期；38.5%行淋巴结清扫术，46.2%行腹膜活检和/或网膜切除术，65.4%行腹腔冲洗术。7 例患者接受辅助化疗。总复发率为 11.5%：所有复发均发生在接受不完全分期手术的患者中。接受辅助化疗的患者均未复发。1 例患者出现盆腔复发，1 例患者出现腹盆腔腹膜和淋巴结复发，第 3 例患者出现腹膜、淋巴结和残留卵巢复发。所有复发患者均通过挽救治疗治愈：2 例患者接受手术联合化疗，1 例仅接受化疗。中位随访 100 个月后，所有患者均存活且无疾病证据。6 例患者选择受孕并分娩了健康婴儿，其中 2 例采用 IVF 加供卵。
IA 期 POD 的预后极佳。行完全手术分期的保守手术是金标准。对于行不完全分期手术的患者，可行再次手术分期或观察。对于复发患者，应行化疗，治疗成功率较高。
