Qin Beijiao, 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.
Breast Tumor Center, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, Guangzhou, People's Republic of China.
Int J Gynecol Cancer. 2019 Feb;29(2):398-403. doi: 10.1136/ijgc-2018-000078. Epub 2019 Jan 23.
To evaluate the role of omentectomy and lymphadenectomy in the treatment of clinically apparent early-stage malignant ovarian germ cell tumors.
We retrospectively reviewed 245 patients with malignant ovarian germ cell tumors (yolk sac tumor, dysgerminoma, and immature teratoma) and with clinically early-stage disease, who were treated at Sun Yat-sen University Cancer Center between January 1, 1970 and December 31, 2017. The survival of patients who underwent either omentectomy or lymphadenectomy, or both (omentectomy/lymphadenectomy group) was compared with that of patients who did not undergo omentectomy or lymphadenectomy (non-omentectomy/lymphadenectomy group).
Sixty patients were diagnosed with yolk sac tumor, 74 with dysgerminoma, and 111 with immature teratoma. Of these 245 patients, 216 patients had stage I disease, 28 patients had stage II, and 1 patient had stage IIIA. There were 190 patients who underwent omentectomy and/or lymphadenectomy and 55 patients in the non-omentectomy/lymphadenectomy group, respectively. In the omentectomy/lymphadenectomy group, 112 patients underwent both omentectomy and lymphadenectomy, 71 underwent omentectomy only, and 7 underwent lymphadenectomy only. Two hundred and fourteen of 245 patients (87.3%) received post-operative chemotherapy. Median follow-up was 73 months (range 1-388). The 10-year overall survival rates in the omentectomy/lymphadenectomy group and non-omentectomy/lymphadenectomy groups were 96.8% and 100%, respectively (p=0.340). Multivariate analysis evaluating all potential prognostic factors showed that omentectomy and lymphadenectomy are not prognostic factors for survival.
Omentectomy and lymphadenectomy do not appear to improve survival and may be omitted in patients with clinically apparent early-stage malignant ovarian germ cell tumors.
评估大网膜切除术和淋巴结切除术在临床分期为早期的恶性卵巢生殖细胞肿瘤治疗中的作用。
我们回顾性分析了1970年1月1日至2017年12月31日在中山大学肿瘤防治中心接受治疗的245例恶性卵巢生殖细胞肿瘤（卵黄囊瘤、无性细胞瘤和未成熟畸胎瘤）且临床分期为早期的患者。将接受大网膜切除术或淋巴结切除术或两者均接受（大网膜切除术/淋巴结切除术组）的患者生存率与未接受大网膜切除术或淋巴结切除术（非大网膜切除术/淋巴结切除术组）的患者生存率进行比较。
60例患者诊断为卵黄囊瘤，74例为无性细胞瘤，111例为未成熟畸胎瘤。在这245例患者中，216例为Ⅰ期疾病，28例为Ⅱ期，1例为ⅢA期。分别有190例患者接受了大网膜切除术和/或淋巴结切除术，55例患者在非大网膜切除术/淋巴结切除术组。在大网膜切除术/淋巴结切除术组中，112例患者同时接受了大网膜切除术和淋巴结切除术，71例仅接受了大网膜切除术，7例仅接受了淋巴结切除术。245例患者中有214例（87.3%）接受了术后化疗。中位随访时间为73个月（范围1 - 388个月）。大网膜切除术/淋巴结切除术组和非大网膜切除术/淋巴结切除术组的10年总生存率分别为96.8%和100%（p = 0.340）。评估所有潜在预后因素的多因素分析表明，大网膜切除术和淋巴结切除术不是生存的预后因素。
大网膜切除术和淋巴结切除术似乎并不能提高生存率，对于临床分期为早期的恶性卵巢生殖细胞肿瘤患者，可能无需进行。
