Nasioudis Dimitrios, Frey Melissa K, Chapman-Davis Eloise, Caputo Thomas A, Holcomb Kevin
Department of Obstetrics and Gynecology, Hospital of the University of Pennsylvania, Philadelphia, PA, USA; Department of Obstetrics and Gynecology, Weill Cornell Medicine, New York, NY, USA.
Department of Obstetrics and Gynecology, Weill Cornell Medicine, New York, NY, USA.
Gynecol Oncol. 2017 Dec;147(3):493-496. doi: 10.1016/j.ygyno.2017.10.010. Epub 2017 Oct 9.
To evaluate the prevalence and safety of uterine preservation among premenopausal women diagnosed with a malignant ovarian germ-cell tumor (MOGCT) of advanced stage (stage II-IV).
The National Cancer Database was accessed and a cohort of women aged <40years, diagnosed with a MOGCT were identified. Those with stage II-IV disease who underwent cancer-directed surgery and received chemotherapy were selected for further analysis. Performance of hysterectomy was assessed from site-specific surgery codes. Overall survival (OS) was determined following generation of Kaplan-Meier curves and compared with the log-rank test. A Cox multivariate model was constructed to control for possible confounders.
A total of 526 eligible patients were identified; rate of hysterectomy was 20.2%. Women who had a hysterectomy were older (median age 30.5 vs 20years, p<0.001) and more likely to present with bilateral tumors (12.6% vs 3.8%, p<0.001). No differences were noted based on tumor histology (p=0.67). Rate of uterine preservation was 82.8%, 79.5% and 75% for those with stage II, III and IV disease respectively (p=0.46). There was no difference in OS between women who had hysterectomy and those who did not (p=0.051); five-year OS rates were 87.1% and 94.4% respectively. After controlling for disease stage, tumor histology and patient race, uterine preservation was not associated with a decreased survival (HR: 0.59, 95% CI: 0.28, 1.24, p=0.19).
Uterine preservation was not associated with decreased survival and should be considered in women with advanced stage GCTs interested in future fertility.
评估晚期（II-IV期）绝经前女性恶性卵巢生殖细胞肿瘤（MOGCT）患者子宫保留的患病率及安全性。
检索国家癌症数据库，确定年龄<40岁、诊断为MOGCT的女性队列。选择接受了癌症导向手术并接受化疗的II-IV期疾病患者进行进一步分析。根据特定部位手术编码评估子宫切除术的实施情况。生成Kaplan-Meier曲线后确定总生存期（OS），并采用对数秩检验进行比较。构建Cox多变量模型以控制可能的混杂因素。
共确定526例符合条件的患者；子宫切除术率为20.2%。接受子宫切除术的女性年龄更大（中位年龄30.5岁对20岁，p<0.001），更可能出现双侧肿瘤（12.6%对3.8%，p<0.001）。基于肿瘤组织学未观察到差异（p=0.67）。II期、III期和IV期疾病患者的子宫保留率分别为82.8%、79.5%和75%（p=0.46）。接受子宫切除术和未接受子宫切除术的女性之间OS无差异（p=0.051）；五年OS率分别为87.1%和94.4%。在控制疾病分期、肿瘤组织学和患者种族后，子宫保留与生存率降低无关（HR：0.59，95%CI：0.28，1.24，p=0.19）。
子宫保留与生存率降低无关，对于有未来生育意愿的晚期GCT女性应考虑保留子宫。
