Karalok Alper, Comert Gunsu Kimyon, Kilic Cigdem, Turkmen Osman, Kilic Fatih, Basaran Derman, Boyraz Gokhan, Tekin Özlem Moraloglu, Turan Taner
Etlik Zubeyde Hanim Women's Health Teaching and Research Hospital, Gynecologic Oncology Division, Ankara, Turkey.
Etlik Zubeyde Hanim Women's Health Teaching and Research Hospital, Ankara, Turkey.
J Gynecol Obstet Hum Reprod. 2019 Sep;48(7):461-466. doi: 10.1016/j.jogoh.2019.06.006. Epub 2019 Jun 19.
To evaluate the survival effect of cytoreductive surgery in advanced stage malignant ovarian germ cell tumors (MOGCT).
Clinicopathological data of patients with MOGCT that were treated between 1991 and 2014. Maximal debulking was defined as no gross residual tumor after primary or recurrence surgery; optimal and suboptimal debulking were used for patients with residual tumors of ≤1cm and >1cm, respectively.
In total, 31 patients with advanced stage MOGCT were analyzed. The median age at diagnosis was 21 (14-57) years. The median follow-up duration was 64.1 months. Of these 31 patients; 7 patients underwent sub-optimal debulking, 5 patients had optimal surgery and 18 had maximal debulking. Five-year DFS according to surgical resection rates were 29% in suboptimal debulking group, 75% in optimal debulking group and 93% in maximal cytoreduction group (p<0.001). Three of seven patients who underwent sub-optimal debulking were died of disease, however no deaths were seen in patients with optimal and maximal debulking. Five-year OS was 32% in suboptimal debulking group, and 100% in optimal and maximal debulking groups (p=0.001).
The benefit of cytoreductive surgery is less well-established in MOGCT of ovary compared to ovarian tumors of epithelial origin due to rareness of this histological subtype. Patients with MOGCT are usually younger and preservation of fertility is an important issue which may lead to suboptimal procedures, sometimes in exchange for diminished survival. Our data demonstrated that maximal cytoreduction should be aimed in patients with advanced stage MOGCT, as it is significantly associated with improved overall survival.
评估减瘤手术对晚期恶性卵巢生殖细胞肿瘤（MOGCT）的生存效果。
1991年至2014年间接受治疗的MOGCT患者的临床病理资料。最大程度减瘤定义为初次或复发性手术后无肉眼可见残留肿瘤；对于残留肿瘤≤1cm和>1cm的患者，分别采用最佳减瘤和次优减瘤。
共分析了31例晚期MOGCT患者。诊断时的中位年龄为21（14 - 57）岁。中位随访时间为64.1个月。在这31例患者中，7例接受了次优减瘤，5例接受了最佳手术，18例接受了最大程度减瘤。根据手术切除率，次优减瘤组的5年无病生存率为29%，最佳减瘤组为75%，最大程度减瘤组为93%（p<0.001）。7例接受次优减瘤的患者中有3例死于疾病，而最佳减瘤和最大程度减瘤的患者均未死亡。次优减瘤组的5年总生存率为32%，最佳减瘤组和最大程度减瘤组均为100%（p = 0.001）。
与上皮性卵巢肿瘤相比，减瘤手术在卵巢MOGCT中的益处尚未得到充分证实，因为这种组织学亚型较为罕见。MOGCT患者通常较年轻，保留生育功能是一个重要问题，这可能导致手术不充分，有时会以生存降低为代价。我们的数据表明，晚期MOGCT患者应争取最大程度减瘤，因为这与总体生存率的显著提高相关。
