恶性卵巢生殖细胞肿瘤：基于人群的挪威队列（1953-2009 年）的表现、生存和第二癌。

Malignant ovarian germ cell tumors: presentation, survival and second cancer in a population based Norwegian cohort (1953-2009).

机构信息

Department of Gynaecologic Oncology, Oslo University Hospital, The Norwegian Radium Hospital, Oslo, Norway; National Resource Centre for Late Effects after Cancer Treatment, Oslo University Hospital, The Norwegian Radium Hospital, Oslo, Norway.

出版信息

Gynecol Oncol. 2013 Nov;131(2):330-5. doi: 10.1016/j.ygyno.2013.08.028. Epub 2013 Aug 31.

DOI:10.1016/j.ygyno.2013.08.028

PMID:24001518

Abstract

PURPOSE

To quantify and compare survival in women with malignant ovarian germ cell tumors (MOGCTs) in Norway before and after the introduction of cisplatin-based chemotherapy (around 1980), and to explore the association between different types of treatment and the development of a second cancer.

PATIENTS AND METHODS

We identified 351 patients diagnosed with MOGCTs from 1953 to 2009 in the Cancer Registry of Norway. Ovarian cancer-specific survival was calculated separately for patients diagnosed before and after 1980. Patients were divided into subgroups by histological subtype (pure dysgerminoma, malignant teratoma, other MOGCTs) and extent of disease (localized and metastatic). We estimated the cumulative incidence of a second cancer in 10-year MOGCT survivors. Kaplan-Meier estimates were used, and p<0.05 was considered significant.

RESULTS

20-Year ovarian cancer-specific survival increased from 59% (95% CI 51% to 66%) before 1980 to 88% (95% CI 83%-93%) thereafter. Significant improvement was observed in all subgroups. No second cancer was diagnosed in any of 31 10-year MOGCT survivors treated with surgery only; second cancer was diagnosed in 23 of 139 patients who underwent cytotoxic treatment (98 radiotherapy ± chemotherapy, 41 chemotherapy only; p=0.08). Patients aged >50 years had a significantly poorer ovarian cancer-specific survival than younger patients (HR=5.98, 95% CI 3.39-10.57) after adjustment for histological subtype and stage at presentation. Our results favor the treatment of patients with metastatic MOGCTs at large cancer centers.

CONCLUSION

Today women with MOGCTs have an excellent prognosis if treated according to modern therapeutic principles.

摘要

目的

在引入顺铂为基础的化疗（约 1980 年前后）前后，量化并比较挪威恶性卵巢生殖细胞肿瘤（MOGCT）女性患者的生存情况，并探讨不同治疗类型与第二癌发生之间的关系。

方法

我们从挪威癌症登记处中确定了 351 例于 1953 年至 2009 年期间诊断为 MOGCT 的患者。分别计算了 1980 年前和 1980 年后诊断的患者的卵巢癌特异性生存率。根据组织学亚型（单纯生殖细胞瘤、恶性畸胎瘤、其他 MOGCT）和疾病程度（局限性和转移性）将患者分为亚组。我们估计了 10 年 MOGCT 幸存者的第二癌累积发生率。使用 Kaplan-Meier 估计，p<0.05 被认为有统计学意义。

结果

20 年卵巢癌特异性生存率从 1980 年前的 59%（95%CI 51%-66%）提高至此后的 88%（95%CI 83%-93%）。所有亚组均观察到显著改善。仅接受手术治疗的 31 例 10 年 MOGCT 幸存者中无一例诊断出第二癌；接受细胞毒性治疗的 139 例患者中有 23 例（98 例接受放疗+化疗，41 例仅接受化疗；p=0.08）诊断出第二癌。经组织学亚型和发病时的分期调整后，年龄>50 岁的患者的卵巢癌特异性生存率明显低于年轻患者（HR=5.98，95%CI 3.39-10.57）。我们的结果支持对大型癌症中心的转移性 MOGCT 患者进行治疗。