Department of Obstetrics and Gynecology, Peking Union Medical College Hospital, Chinese Academy of Medical Science and Peking Union Medical College, Beijing, 100730, China.
Department of Gynecology and Obstetrics, Beijing Youan Hospital of Capital Medical University, Beijing, China.
Arch Gynecol Obstet. 2020 Apr;301(4):1021-1026. doi: 10.1007/s00404-020-05452-2. Epub 2020 Mar 20.
Due to the rarity of recurrent and persistent malignant ovarian germ cell tumors (MOGCTs), there is no standardized protocol for salvage therapy. This study aimed to investigate the outcomes and prognostic factors of patients with recurrent and persistent MOGCTs.
Clinical data for 59 patients with recurrent and persistent MOGCTs admitted to Peking Union Medical College Hospital from January 1, 2000, to April 30, 2018, were retrospectively analyzed.
Twenty-one cases (35.6%) were recurrent, and 38 (64.4%) were persistent. Patient age ranged from 1 to 39 years, and disease stage was as follows: 33 stage I, 4 stage II, 21 stage III, and 1 stage IV. There were 19 immature teratomas, 26 yolk sac tumors, 1 dysgerminoma, and 13 mixed germ cell tumors. Regarding the primary surgery, fertility was preserved in 49 patients and not preserved in 10 patients. Among the patients who underwent fertility-preserving primary surgery, 40 had fertility preserved in the second operation, and 9 did not. In the mean follow-up of 52.6 months (range 2-279 months) after recurrence, 19 patients (32.2%) experienced a second relapse, and 16 (27.1%) died. The 5-year survival and progression-free survival rates after relapse were 70.0% and 67.0%, respectively. The optimal salvage surgery and chemotherapy regimen after relapse were independent prognostic factors (P < 0.05).
The prognosis of recurrent and persistent MOGCTs was good after salvage therapy. The optimal salvage surgery and adjuvant standardized chemotherapy significantly impact patient prognosis. For young nulliparous patients, secondary fertility-sparing salvage therapy can be considered.
由于复发性和持续性卵巢恶性生殖细胞肿瘤（MOGCT）较为罕见，因此尚无针对其挽救性治疗的标准化方案。本研究旨在探讨复发性和持续性 MOGCT 患者的治疗效果和预后因素。
回顾性分析 2000 年 1 月 1 日至 2018 年 4 月 30 日期间在北京协和医院接受治疗的 59 例复发性和持续性 MOGCT 患者的临床资料。
21 例（35.6%）为复发性肿瘤，38 例（64.4%）为持续性肿瘤。患者年龄为 139 岁，疾病分期为：33 例Ⅰ期，4 例Ⅱ期，21 例Ⅲ期，1 例Ⅳ期。肿瘤组织学类型为：19 例未成熟畸胎瘤，26 例卵黄囊瘤，1 例单纯生殖细胞瘤，13 例混合性生殖细胞肿瘤。初次手术中，49 例患者保留了生育功能，10 例患者未保留。在接受保留生育功能初次手术的患者中，40 例在二次手术中保留了生育功能，9 例未保留。在复发后的平均随访 52.6 个月（范围 2279 个月）中，19 例（32.2%）患者出现第二次复发，16 例（27.1%）患者死亡。复发后 5 年生存率和无进展生存率分别为 70.0%和 67.0%。复发后最佳的挽救性手术和化疗方案是独立的预后因素（P < 0.05）。
复发性和持续性 MOGCT 经挽救性治疗后预后良好。最佳的挽救性手术和辅助标准化化疗方案显著影响患者的预后。对于年轻的未育患者，可以考虑进行二次保留生育功能的挽救性治疗。
