Department of Obstetrics and Gynecology, IRCCS San Raffaele Hospital, Milan, Italy; Università Vita Salute San Raffaele, Milan, Italy.
Department of Medical Oncology, Charing Cross Hospital Campus of Imperial College London, London, UK.
Eur J Cancer. 2020 Sep;137:136-143. doi: 10.1016/j.ejca.2020.06.033. Epub 2020 Aug 4.
The role of surveillance after surgery for stage IA-C grade 2 (G2) or grade 3 (G3) immature teratomas (ITs) is controversial with many guidelines advocating adjuvant chemotherapy. Here, we investigate the safety of surveillance in stage IA-C G1-3 ITs.
Clinicopathological data were analysed on postpubertal patients with stage I pure ITs in Multicenter Italian Trials in Ovarian Cancer centres and at Charing Cross Hospital, UK, between January 1985 and January 2018.
Of 108 stage I patients, 66 (61.1%), 3 (2.8%) and 39 (36.1%) were International Federation of Gynecology and Obstetrics IA, IB, IC, respectively, with 31 (28.7%), 41 (38%) and 36 (33.3%) having grade 1 (G1), 2 and 3 disease, respectively. After surgery, 27 patients (25%) had adjuvant chemotherapy and 81 (75%) surveillance. There was no significant increase in the risk of malignant (G2-3 IT) relapse (9/81 vs 2/27; p = 0.72) or in disease-free survival (DFS) or overall survival in the surveillance vs chemotherapy groups. The median time to relapse was 17.8 months (range: 3-47) with no significant difference between surveillance or chemotherapy groups. The median follow-up was 64.3 months (Interquartile range (IQR) 22.2-101.7). Chemotherapy induced cures in all except for one patient who did not follow the surveillance protocol due to pregnancy and died of disease. Univariate and multivariate analyses revealed that only tumour grade (hazard ratio [HR] = 3.11; p = 0.02) and complete surgical staging (HR = 0.2; p = 0.01) were independent prognostic factors for decreased DFS.
The present study suggests that in the adult setting careful surveillance appears to be an acceptable alternative to adjuvant chemotherapy for stage IA-C ITs of any grade, properly staged and with negative postoperative tumour markers.
对于 IA-C 期 G2 或 G3 未成熟畸胎瘤（IT）的患者，术后监测的作用存在争议，许多指南都主张辅助化疗。在此，我们研究了 IA-C 期 G1-3 IT 患者监测的安全性。
对 1985 年 1 月至 2018 年 1 月期间在意大利多中心卵巢癌中心和英国查令十字医院接受治疗的青春期后患者的临床病理数据进行了分析。这些患者患有单纯的 IA 期 IT，且分期为 I 期。
108 例 IA 期患者中，IA、IB、IC 期分别为 66 例（61.1%）、3 例（2.8%）和 39 例（36.1%），其中 31 例（28.7%）、41 例（38%）和 36 例（33.3%）为 G1、2 和 3 级疾病。手术后，27 例（25%）患者接受了辅助化疗，81 例（75%）患者接受了监测。在监测组和化疗组中，恶性（G2-3 IT）复发（9/81 例 vs 2/27 例；p=0.72）或无病生存（DFS）或总生存无显著差异。复发中位时间为 17.8 个月（范围：3-47），监测组和化疗组之间无显著差异。中位随访时间为 64.3 个月（四分位距（IQR）22.2-101.7）。化疗除了一名因怀孕未遵循监测方案且死于疾病的患者外，均治愈了所有患者。单因素和多因素分析显示，只有肿瘤分级（风险比[HR] = 3.11；p=0.02）和完全手术分期（HR = 0.2；p=0.01）是 DFS 降低的独立预后因素。
本研究表明，在成人中，对于分期适当且术后肿瘤标志物阴性的任何分级的 IA-C 期 IT，仔细监测似乎是辅助化疗的一种可接受的替代方法。
