Gershenson D M
Department of Gynecologic Oncology, University of Texas M. D. Anderson Cancer Center, Houston 77030.
Gynecol Oncol. 1994 Dec;55(3 Pt 2):S62-72.
Malignant ovarian germ cell tumors (OGCT) and sex cord-stromal tumors (OSCST), each of which account for less than 5% of all ovarian malignancies, are much less common than epithelial ovarian cancer. In young patients suspected of having an OGCT, laparotomy is initially indicated for both diagnosis and treatment. For most patients, unilateral salpingo-oophorectomy with preservation of the contralateral ovary and the uterus is appropriate. The basis for this surgical approach is retrospective studies that show an equivalent cure rate for patients who undergo unilateral or bilateral adnexectomy. No prospective studies have compared unilateral with bilateral adnexectomy. Surgical staging is also important to determine the extent of disease, to determine prognosis, and to guide postoperative management. If metastatic disease is encountered during initial surgery for OGCT, the same principles of cytoreductive surgery that have been applied to surgically manage advanced epithelial ovarian cancer are recommended, with resection of as much tumor as is technically feasible and safe. For all OGCT patients except those with well-documented stage IA grade 1 pure immature teratoma or stage IA pure dysgerminoma, postoperative chemotherapy is indicated. The current recommended regimen for OGCT is bleomycin, etoposide, and cisplatin--a combination that appears to result in at least a 95% cure rate for stage I disease and at least a 75% cure rate for advanced-stage disease. For patients with metastatic dysgerminoma, chemotherapy, which has the advantage of preserving fertility in the majority of patients, has supplanted radiotherapy as standard treatment. For patients with OSCST, no standard therapy exists. Surgery alone is currently acceptable treatment for all patients with OSCST except those who have metastatic disease or Sertoli-Leydig cell tumors with poor differentiation or heterologous elements. Currently, platinum-based combination chemotherapy is favored for these latter patients, but the activity of such regimens appears only modest.
恶性卵巢生殖细胞肿瘤（OGCT）和性索间质肿瘤（OSCST），每种肿瘤在所有卵巢恶性肿瘤中所占比例均不到5%，比上皮性卵巢癌少见得多。对于怀疑患有OGCT的年轻患者，剖腹手术最初用于诊断和治疗。对于大多数患者，行单侧输卵管卵巢切除术并保留对侧卵巢和子宫是合适的。这种手术方法的依据是回顾性研究，该研究表明接受单侧或双侧附件切除术的患者治愈率相当。尚无前瞻性研究比较单侧与双侧附件切除术。手术分期对于确定疾病范围、判断预后以及指导术后管理也很重要。如果在OGCT的初次手术中发现转移性疾病，建议采用与手术治疗晚期上皮性卵巢癌相同的细胞减灭术原则，即在技术可行且安全的情况下尽可能切除肿瘤。对于所有OGCT患者，除了那些有充分记录的IA期1级纯未成熟畸胎瘤或IA期纯无性细胞瘤患者外，术后均需化疗。目前推荐的OGCT化疗方案是博来霉素、依托泊苷和顺铂——该联合方案似乎能使I期疾病的治愈率至少达到95%，晚期疾病的治愈率至少达到75%。对于转移性无性细胞瘤患者，化疗已取代放疗成为标准治疗方法，其优点是大多数患者可保留生育能力。对于OSCST患者，尚无标准治疗方法。目前，对于所有OSCST患者，除了那些有转移性疾病或分化不良或有异源性成分的支持间质细胞瘤患者外，单纯手术是可接受的治疗方法。目前，铂类联合化疗更适合后一类患者，但此类方案的活性似乎一般。
