使用改良的国际生殖细胞癌合作组织分类系统预测恶性卵巢生殖细胞肿瘤的结局。

Predicting outcomes in malignant ovarian germ cell tumors using the modified International Germ Cell Cancer Collaborative Group classification system.

机构信息

Obstetrics and Gynecology, Peking Union Medical College Hospital, Beijing, China.

Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China.

出版信息

Int J Gynecol Cancer. 2024 Nov 4;34(11):1745-1752. doi: 10.1136/ijgc-2024-005489.

DOI:10.1136/ijgc-2024-005489

PMID:39019492

Abstract

OBJECTIVES

The aim of our study was to evaluate the feasibility of the modified International Germ Cell Cancer Collaborative Group risk classification system in Chinese female patients with malignant ovarian germ cell tumors and to identify predictive factors to enhance the risk classification system.

METHODS

In this retrospective cohort analysis, patients with malignant ovarian germ cell tumors who received surgery with/without chemotherapy were included. These patients had been followed-up by Peking Union Medical College Hospital between 2011 to 2020. Patients without complete medical records or no follow-up information were excluded.

RESULTS

The study enrolled a total of 271 patients. The risk model classified 106 (39.1%) patients as good-, 84 (31%) as intermediate-, and 81 (29.9%) as poor-risk. With a median follow-up time of 34 months (range 2-147), 48 (17.7%) recurrence and 16 (5.9%) deaths were observed. The risk classification significantly correlated with 3 year disease-free survival and overall survival (log rank p<0.001 and p=0.003, respectively). The survival outcomes of disease-free survival and overall survival were not statistically different among risk groups in patients who received neoadjuvant chemotherapy (log rank p=0.77 and 0.41, respectively). Univariate and multivariable analysis showed that tumor stage (p=0.033, hazard ratio (HR) 2.05, 95% confidence interval (CI) 1.06 to 3.96) was significantly associated with relapse or progression of disease. Patients over age 40 years exhibited a poor prognosis.

CONCLUSION

The modified International Germ Cell Cancer Collaborative Group risk classification system was efficacious in patients with malignant ovarian germ cell tumors and was significantly associated with disease-free survival and overall survival. Risk assessment after neoadjuvant chemotherapy may be more predictive than stratification at initial diagnosis. Age and tumor stage were definitive prognostic factors for germ cell tumors, which may need to be incorporated in the stratification system.

摘要

目的

本研究旨在评估改良的国际生殖细胞癌协作组风险分类系统在中国女性恶性卵巢生殖细胞肿瘤患者中的可行性，并确定预测因素以增强风险分类系统。

方法

在这项回顾性队列分析中，纳入了接受手术联合/不联合化疗的恶性卵巢生殖细胞肿瘤患者。这些患者于 2011 年至 2020 年期间在北京协和医院接受随访。排除无完整病历或无随访信息的患者。

结果

研究共纳入 271 例患者。风险模型将 106 例（39.1%）患者分为低危组，84 例（31%）为中危组，81 例（29.9%）为高危组。中位随访时间为 34 个月（范围 2-147），观察到 48 例（17.7%）复发和 16 例（5.9%）死亡。风险分类与 3 年无病生存率和总生存率显著相关（对数秩检验 p<0.001 和 p=0.003）。在接受新辅助化疗的患者中，无病生存率和总生存率的风险组间差异无统计学意义（对数秩检验 p=0.77 和 0.41）。单因素和多因素分析显示，肿瘤分期（p=0.033，风险比（HR）2.05，95%置信区间（CI）1.06 至 3.96）与疾病复发或进展显著相关。年龄大于 40 岁的患者预后较差。