Hatzipetros Ioannis, Gocze Peter M, Cziraky Katalin, Kovacs Kalman, Kalman Endre, Farkas Balint
Department of Obstetrics and Gynaecology, University of Pecs, Clinical Centre, Edesanyak Str, 17, 7624 Pecs, Hungary.
Reprod Biol Endocrinol. 2013 Sep 12;11:91. doi: 10.1186/1477-7827-11-91.
Although some studies have reported a potential connection between ovulation induction therapy (OIT) and malignant ovarian diseases, the results have been inconclusive. In the present study, we sought to determine whether women undergoing OIT at our in vitro fertilization (IVF) clinic, especially those with severe ovarian hyperstimulation syndrome (OHSS) and suspicious cytologic findings, were at risk for developing malignant ovarian tumours after treatment.
Patients who underwent OIT at our IVF clinic were enrolled in this study and assessed for any evidence of malignant ovarian tumours. Patients who developed severe OHSS as a result of OIT were treated with a culdocentesis. Cells from the ascitic fluid were cytologically scored for abnormality and malignancy. Peripheral blood samples were obtained from patients with severe OHSS to determine serum levels of the tumour markers (CA-125 and HE4) that were used to calculate the Risk for Ovarian Malignancy Algorithm (ROMA) index.
Follow-up data were available for 1,353 of the 1,587 patients (85%) who underwent OIT at our IVF clinic between January 2006 and December 2012. Twenty-three patients (1.4%) were hospitalized with OHSS. Culdocentesis was performed 16 times in nine patients with severe OHSS (age range, 23-34 years; mean, 27.1 years). Although cytological examination of the ascitic cells of these patients suggested malignant ovarian neoplasia, over the course of the observation period, the ovarian volume gradually decreased and became normal. Subsequent cytological and histological examinations failed to find evidence of any malignant tumours in these nine patients. None of the 1,353 participants who underwent OIT developed any malignant ovarian tumours during the study period. Moreover, none of the 462 patients who were in our ovarian tumour registry were also participants in the IVF program.
The presence of atypical cells in the ascitic fluid of women with severe OHSS does not likely indicate malignancy; therefore, radical surgical intervention is not justified. The risk of malignancy is minimal shortly after OIT. At our centre, OIT has not been associated with any cases of ovarian tumour.
尽管一些研究报告了促排卵治疗（OIT）与恶性卵巢疾病之间可能存在联系，但结果尚无定论。在本研究中，我们试图确定在我们体外受精（IVF）诊所接受OIT治疗的女性，尤其是那些患有严重卵巢过度刺激综合征（OHSS）且细胞学检查结果可疑的女性，在治疗后是否有发生恶性卵巢肿瘤的风险。
在我们IVF诊所接受OIT治疗的患者被纳入本研究，并评估是否有恶性卵巢肿瘤的任何证据。因OIT导致严重OHSS的患者接受了后穹窿穿刺术。对腹水细胞进行细胞学评分，以判断异常和恶性程度。从患有严重OHSS的患者中采集外周血样本，以测定肿瘤标志物（CA - 125和HE4）的血清水平，用于计算卵巢恶性肿瘤风险算法（ROMA）指数。
在2006年1月至2012年12月期间，在我们IVF诊所接受OIT治疗的1587例患者中，有1353例（85%）获得了随访数据。23例患者（1.4%）因OHSS住院。对9例严重OHSS患者（年龄范围23 - 34岁，平均27.1岁）进行了16次后穹窿穿刺术。尽管这些患者腹水细胞的细胞学检查提示为恶性卵巢肿瘤，但在观察期内，卵巢体积逐渐缩小并恢复正常。随后的细胞学和组织学检查未能在这9例患者中发现任何恶性肿瘤的证据。在研究期间，接受OIT治疗的1353名参与者中没有一人发生任何恶性卵巢肿瘤。此外，在我们卵巢肿瘤登记处的462例患者中，没有一人同时参与IVF项目。
严重OHSS女性腹水中存在非典型细胞不太可能表明为恶性；因此，激进的手术干预不合理。OIT后不久发生恶性肿瘤的风险极小。在我们中心，OIT与任何卵巢肿瘤病例均无关联。
