Department of Gynecologic 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.
Department of Gynecologic Oncology & Reproductive Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX, United States.
Eur J Cancer. 2014 Jul;50(11):1942-50. doi: 10.1016/j.ejca.2014.03.288. Epub 2014 May 20.
To evaluate the prognostic significance of age at diagnosis, extent of the disease (EOD) and socioeconomic (SES) and sociodemographic status (civil status, residency) on cause specific survival (CSS) in patients with malignant ovarian germ cell tumours (MOGCTs). To explore the cumulative incidence of a second cancer in 10-year MOGCT survivors.
2541 patients with MOGCT, reported to the Surveillance, Epidemiology and End Results programme (1978-2010), were identified. The above mentioned prognostic factors were assessed separately for dysgerminoma and non-dysgerminoma, using Kaplan-Meier estimates and Cox Hazards Models, providing 95% confidence intervals (95% CI).
Five-year CSS was 97% (95% CI, 96-98%), and 92% (95% CI, 91-93%), respectively for dysgerminoma, and non-dysgerminoma. Age >40 years at diagnosis and presence of metastases were significantly associated with cause specific mortality. Among non-dysgerminoma patients, decreasing SES (hazard ratio (HR), 1.59; 95% CI, 1.11-2.28) and treatment before 1990 (HR, 2.65; 95% CI, 1.83-3.85) increased mortality. In the adjusted analysis, patients from Michigan were almost 2.5 times more likely to die from MOGCT than patients from other states (HR, 2.48; 95% CI, 1.17-5.25). Second cancer was diagnosed in 10% of 10-year survivals who underwent radiotherapy and in 2% of survivals in non-radiotherapy group (p=.002).
Increased attention should be directed towards the management of elderly MOGCT patients and those with non-dysgerminoma histology with low SES. Radiotherapy should be avoided as much as possible. Survival differences related to residency may occur when new cancer treatments are introduced.
评估诊断时的年龄、疾病程度（EOD）以及社会经济（SES）和社会人口统计学（婚姻状况、居住地点）对恶性卵巢生殖细胞肿瘤（MOGCT）患者的特定原因生存（CSS）的预后意义。探讨 10 年 MOGCT 幸存者中第二癌症的累积发生率。
从监测、流行病学和最终结果计划（1978-2010 年）中确定了 2541 名患有 MOGCT 的患者。使用 Kaplan-Meier 估计和 Cox 危害模型分别评估了畸胎瘤和非畸胎瘤患者的上述预后因素，并提供了 95%置信区间（95%CI）。
诊断后 5 年的 CSS 分别为 97%（95%CI，96-98%）和 92%（95%CI，91-93%），分别为畸胎瘤和非畸胎瘤。诊断时年龄>40 岁和存在转移与特定原因死亡率显著相关。在非畸胎瘤患者中，SES 降低（危险比（HR），1.59；95%CI，1.11-2.28）和 1990 年前治疗（HR，2.65；95%CI，1.83-3.85）增加了死亡率。在调整分析中，密歇根州的患者死于 MOGCT 的可能性几乎是其他州患者的 2.5 倍（HR，2.48；95%CI，1.17-5.25）。在接受放疗的 10 年幸存者中，有 10%诊断出第二癌症，在未接受放疗的幸存者中，有 2%（p=0.002）。
应更加关注老年 MOGCT 患者和 SES 较低的非畸胎瘤患者的管理。应尽可能避免放疗。当引入新的癌症治疗方法时，可能会出现与居住地点相关的生存差异。
