Xu Wenyan, Li Yanfang
Department of Gynecologic Oncology, Sun Yat-sen University Cancer Center; State Key Laboratory of Oncology in South China; Collaborative Innovation Center for Cancer Medicine, Guangzhou, People's Republic of China.
Int J Gynecol Cancer. 2017 Sep;27(7):1373-1378. doi: 10.1097/IGC.0000000000001012.
The aim of the study was to investigate whether omentectomy (OMT) is necessary in the operation for apparently early stage malignant ovarian germ cell tumors (MOGCTs).
Searching medical records database of Sun Yat-sen University Cancer Center from January 1, 1966, to November 30, 2015, patients with MOGCTs were identified and their age, year of diagnosis, tumor grade, histologic subtype, International Federation of Gynecology and Obstetrics stage, nodal findings, gross observation of omentum, and performance of OMT were assessed. Overall survivals of patients with or without OMT were compared using Kaplan-Meier survival curves.
A total of 223 MOGCT cases with clinically early stage (stage I and II) disease and with the 3 common histological subtypes of MOGCT were obtained, which include yolk sac tumor (YST), dysgerminoma (DSG), and immature teratoma (IMT). There were 192 stage I cases and 31 stage II cases. Fifty-four patients were diagnosed with YST, 61 with DSG, and 108 with IMT. Omentectomy was performed as part of the initial surgery in 74.0% patients (165/223) and was omitted in 26.0% patients (58/223). Chemotherapy was administered in 88.3% (197/223) of all patients. The median follow-up was 82.0 months. The 10-year overall survival rates of the patients with and without OMT were 90.5% and 98.1%, respectively (P = 0.156). Regarding different stages or histological subtypes, the 10-year survival rates of the 2 groups were 92.0% versus 97.9% (P = 0.324, stage I), 83.2% versus 100% (P = 0.351, stage II), 89.2% versus 100% (P = 0.303, YST), 94.1% versus 100% (P = 0.470, DSG), and 89.4% versus 96.0% (P = 0.405, IMT), respectively.
In conclusion, OMT in patients with clinically early stage MOGCT may not improve patient survival and may be omitted.
本研究旨在探讨对于明显早期的恶性卵巢生殖细胞肿瘤（MOGCTs）手术时是否有必要行大网膜切除术（OMT）。
检索中山大学肿瘤防治中心1966年1月1日至2015年11月30日的病历数据库，确定MOGCTs患者，并评估其年龄、诊断年份、肿瘤分级、组织学亚型、国际妇产科联盟分期、淋巴结情况、大网膜大体观察及OMT实施情况。采用Kaplan-Meier生存曲线比较行OMT和未行OMT患者的总生存率。
共获得223例临床早期（Ⅰ期和Ⅱ期）且具有MOGCTs 3种常见组织学亚型的病例，包括卵黄囊瘤（YST）、无性细胞瘤（DSG）和未成熟畸胎瘤（IMT）。其中Ⅰ期病例192例，Ⅱ期病例31例。54例患者诊断为YST，61例为DSG，108例为IMT。74.0%（165/223）的患者在初次手术时行了大网膜切除术，26.0%（58/223）的患者未行。88.3%（197/223）的患者接受了化疗。中位随访时间为82.0个月。行OMT和未行OMT患者的10年总生存率分别为90.5%和98.1%（P = 0.156）。对于不同分期或组织学亚型，两组的10年生存率分别为92.0%对97.9%（P = 0.324，Ⅰ期）、83.2%对100%（P = 0.351，Ⅱ期）、89.2%对100%（P = 0.303，YST）、94.1%对100%（P = 0.470，DSG）、89.4%对96.0%（P = 0.405，IMT）。
总之，临床早期MOGCTs患者行OMT可能无法提高患者生存率，可省略该手术。
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