General Surgery Department, Faculty of Medicine, Helwan University, Cairo, Egypt.
Surgical Oncology Department, Children's Cancer Hospital 57357, Cairo, Egypt.
World J Surg Oncol. 2024 Jul 4;22(1):176. doi: 10.1186/s12957-024-03452-z.
We present an Egyptian study on pediatric ovarian immature teratomas (ITs), aiming to clarify our treatment strategy selection.
A retrospective review of all children with pure ovarian ITs who were treated at our institution between 2008 and 2023. The analysis included clinical characteristics, tumor staging according to Children's Oncology Group (COG), grading based on the Norris system, management, and outcomes.
Thirty-two patients were included, with a median age of 9 years. All patients underwent primary surgery. Unilateral salpingo-oophorectomy was performed in 31 patients. Surgical staging was completed in all patients. Based on COG staging, there were 28 patients (87.5%) stage I, 1 (3%) stage II, and 3 (9.5%) stage III. According to Norris classification, 16 patients (50%) were classified as grade I, 9 (28%) grade II, and 7 (22%) grade III. All patients in stage I were treated using surgery-alone approach, whereas the remaining four (12.5%) received adjuvant chemotherapy. Five patients in stage I had gliomatosis peritonei (GP), and none of them underwent extensive surgery. At a median follow-up of 86 months, two patients had events. The first patient (stage III/grade I) developed IT relapse on the operative bed, and the second (stage I/grade I) had a metachronous IT on the contralateral ovary. Both patients were successfully managed with surgery followed by second-line chemotherapy. Five-year overall survival and event-free survival for all patients were 100% and 93.4%, respectively.
Surgery-alone strategy with close follow-up achieves excellent outcomes for localized ovarian ITs in children, irrespective of the Norris grading or the presence of GP. However, adjuvant chemotherapy is questionable for patients with incompletely resected or locally advanced tumors, and its role requires further evaluation through prospective multicentric studies with a larger sample size.
我们展示了一项埃及小儿卵巢未成熟畸胎瘤（IT）的研究，旨在阐明我们的治疗策略选择。
回顾性分析了 2008 年至 2023 年期间在我院治疗的所有单纯卵巢 IT 患儿。分析包括临床特征、根据儿童肿瘤协作组（COG）进行的肿瘤分期、诺里斯系统的分级、治疗方法和结果。
共纳入 32 例患者，中位年龄为 9 岁。所有患者均行初次手术，31 例患者行单侧附件切除术。所有患者均完成手术分期。根据 COG 分期，28 例（87.5%）为Ⅰ期，1 例（3%）为Ⅱ期，3 例（9.5%）为Ⅲ期。根据诺里斯分级，16 例（50%）为Ⅰ级，9 例（28%）为Ⅱ级，7 例（22%）为Ⅲ级。所有Ⅰ期患者均采用手术治疗，其余 4 例（12.5%）接受辅助化疗。Ⅰ期有 5 例患者有腹膜胶质瘤（GP），但均未行广泛手术。中位随访 86 个月时，2 例患者出现事件。第一例（Ⅲ期/Ⅰ级）在手术部位复发 IT，第二例（Ⅰ期/Ⅰ级）对侧卵巢发生异时 IT。两例均成功采用手术联合二线化疗治疗。所有患者的 5 年总生存率和无事件生存率分别为 100%和 93.4%。
对于儿童局限性卵巢 IT，单纯手术结合密切随访可获得良好的结果，无论诺里斯分级或 GP 是否存在。然而，对于未完全切除或局部进展的肿瘤患者，辅助化疗值得商榷，需要通过前瞻性多中心研究进一步评估，该研究应纳入更大的样本量。
