Yang Zhi-jun, Wei Ren-ji, Li Li
Department of Gynecological Oncology, Affiliated Tumor Hospital of Guangxi Medical University, Nanning 530021, China.
Zhonghua Fu Chan Ke Za Zhi. 2012 Dec;47(12):898-904.
To analyse the clinicopathologic factors affecting prognosis and fertility of patients with malignant ovarian germ cell tumor (MOGCT).
The medical records and follow up data of 106 patients with MOGCT treated at Affiliated Tumor Hospital of Guangxi Medical University between January 1986 and December 2010.Kaplan-Meier method was used to analyse survival curves. The different prognoses between different clinicopathologic factor was evaluated by univariate analysis and log-rank test. The multivariate analysis was performed by the Cox proportional hazard regression method. Logistic regression analysis was used to evaluate the influence of different factors on the prognoses and fertility.
The median age at primary treatment was 22 years old (range: 9 - 61 years old), 59 patients received fertility-preserving surgery, 45 patients received radical surgery, only 2 cases performed biopsy; 94 patients received postoperative adjuvant chemotherapy. Median follow-up time was 56.5 months (range: 2 - 309 months), there were 11 cases recurrences, 23 cases died from cancer. Of 47 patients live without tumor, 45 patients had normal menstrual. Of the 39 patients desiring pregnancy, 31 cases got 33 successful pregnancies, resulting in 33 live births. There is no statistically significant difference (P > 0.05) in progression free survival (PFS; 67.6% versus 63.3%) and overall survival (OS; 70.0% versus 64.1%) and mortality [15% (9/59) versus 31% (14/45)] between fertility-preserving surgery patients and radical surgery patients. The univariate analysis showed that the pathological types, postoperative residual tumor size, lymph nodes and omental resection were associated with OS (P < 0.1), and postoperative residual tumor size, chemotherapy cycles, lymph nodes and omental resection were associated with PFS (P < 0.1). The multivariate analysis showed only the postoperative residual tumor size was independent prognostic factor of OS (P = 0.039), and postoperative residual tumor size, chemotherapy cycles, lymph nodes resection were independent prognostic factors of PFS (P < 0.05). There is no statistically significant difference in OS, PFS and fertility between fertility-preserving surgery patients treated with or without a comprehensive staging surgery (P > 0.05).
MOGCT can achieve a good prognosis after surgery combined chemotherapy. Postoperative residual tumor size is independent prognostic factor of PFS and OS. Comprehensive staging surgery could not improve prognosis. Fertility-preserving surgery plus adjuvant chemotherapy appeared to have little or no effect on prognosis and fertility.
分析影响卵巢恶性生殖细胞肿瘤（MOGCT）患者预后及生育功能的临床病理因素。
回顾性分析1986年1月至2010年12月在广西医科大学附属肿瘤医院治疗的106例MOGCT患者的病历及随访资料。采用Kaplan-Meier法分析生存曲线，通过单因素分析和对数秩检验评估不同临床病理因素之间的预后差异，采用Cox比例风险回归方法进行多因素分析，采用Logistic回归分析评估不同因素对预后及生育功能的影响。
初次治疗时的中位年龄为22岁（范围：9 - 61岁），59例行保留生育功能手术，45例行根治性手术，仅2例行活检；94例术后接受辅助化疗。中位随访时间为56.5个月（范围：2 - 309个月），复发11例，死于肿瘤23例。47例无瘤生存患者中，45例月经正常。39例有妊娠意愿的患者中，31例成功妊娠33次，分娩33例活婴。保留生育功能手术患者与根治性手术患者的无进展生存期（PFS；分别为67.6%和63.3%）、总生存期（OS；分别为70.0%和64.1%）及死亡率[15%（9/59）和31%（14/45）]差异无统计学意义（P > 0.05）。单因素分析显示，病理类型、术后残留肿瘤大小、淋巴结及大网膜切除与OS相关（P < 0.1），术后残留肿瘤大小、化疗周期、淋巴结及大网膜切除与PFS相关（P < 0.1）。多因素分析显示，仅术后残留肿瘤大小是OS的独立预后因素（P = 0.039），术后残留肿瘤大小、化疗周期、淋巴结切除是PFS的独立预后因素（P < 0.05）。接受或未接受全面分期手术的保留生育功能手术患者在OS、PFS及生育功能方面差异无统计学意义（P > 0.05）。
MOGCT患者手术联合化疗后可获得较好预后。术后残留肿瘤大小是PFS和OS的独立预后因素。全面分期手术不能改善预后。保留生育功能手术加辅助化疗对预后及生育功能似乎无明显影响。
