Ertas Ibrahim Egemen, Taskin Salih, Goklu Rifat, Bilgin Muzaffer, Goc Goksu, Yildirim Yusuf, Ortac Firat
Department of Gynecologic Oncology, Tepecik Education and Research Hospital, Izmir, Turkey.
J Obstet Gynaecol Res. 2014 Mar;40(3):797-805. doi: 10.1111/jog.12253. Epub 2013 Dec 10.
To evaluate the long-term oncological and reproductive outcomes of patients aged 25 years and younger who were treated by fertility-sparing cytoreductive surgery (FSCS) plus adjuvant chemotherapy (ACT) or observation alone for malignant ovarian germ cell tumors (MOGCT).
Records of 42 eligible female patients treated for MOGCT between 1 May 1995 and 31 December 2010 at two centers were analyzed retrospectively. A telephone questionnaire was performed to gather reproductive and menstrual history.
One patient was treated without FSCS and two patients were lost to follow-up. The mean age of the remaining 39 patients was 18.4 ± 3.2 years. Eighteen of the tumors were histologically pure dysgerminomas (PD) and 21 were non-dysgerminomatous tumors (non-DT). Thirteen patients (33%) presented with stage II-III disease. Optimal cytoreduction was achieved in 34 of the 39 patients (87%). Systematic pelvic and para-aortic lymphadenectomy was performed in 31 of the 39 patients (79.5%). The frequency of lymph node metastasis was 29% (9/31). Twenty-seven patients (69.2%) received ACT. Disease recurred in six (15.3%) patients, all in the non-DT group. Four of six underwent secondary optimal FSCS followed by chemotherapy. Retroperitoneal nodal recurrence was detected in two of these four patients (50%). Four deaths occurred, three due to chemoresistant aggressive disease and one due to secondary acute myelocytic leukemia. The overall survival rates for patients with PD and non-DT were 100% and 81.4%, respectively. Twenty-three of 27 patients who received ACT continued their regular menses. Sixteen spontaneous pregnancies and one pregnancy by intrauterine insemination were achieved by 21 patients who attempted conception.
Either primary or secondary FSCS followed by ACT seems to be a feasible and safe approach to preserving future fertility and hormonal function in young patients with MOGCT.
评估年龄在25岁及以下的恶性卵巢生殖细胞肿瘤（MOGCT）患者，接受保留生育功能的细胞减灭术（FSCS）加辅助化疗（ACT）或单纯观察治疗后的长期肿瘤学和生殖结局。
回顾性分析1995年5月1日至2010年12月31日期间在两个中心接受MOGCT治疗的42例符合条件的女性患者的记录。通过电话问卷收集生殖和月经史。
1例患者未接受FSCS治疗，2例患者失访。其余39例患者的平均年龄为18.4±3.2岁。其中18例肿瘤组织学上为纯无性细胞瘤（PD），21例为非无性细胞瘤（非DT）。13例患者（33%）表现为II - III期疾病。39例患者中有34例（87%）实现了最佳细胞减灭。39例患者中有31例（79.5%）进行了系统性盆腔和腹主动脉旁淋巴结清扫术。淋巴结转移率为29%（9/31）。27例患者（69.2%）接受了ACT。6例（15.3%）患者疾病复发，均在非DT组。6例中的4例接受了二次最佳FSCS，随后进行化疗。这4例患者中有2例（50%）检测到腹膜后淋巴结复发。4例患者死亡，3例死于化疗耐药的侵袭性疾病，1例死于继发性急性髓细胞白血病。PD和非DT患者的总生存率分别为100%和81.4%。接受ACT的27例患者中有23例月经规律。21例尝试受孕的患者中有16例自然受孕，1例通过宫内授精受孕。
对于年轻的MOGCT患者，初次或二次FSCS后加ACT似乎是一种可行且安全的方法，可保留其未来生育能力和激素功能。
