全面分期手术对卵巢恶性生殖细胞肿瘤初治患者预后的影响

Comprehensive staging surgery in treatment of malignant ovarian germ cell tumor

目的探讨全面分期手术对卵巢恶性生殖细胞肿瘤(MOGCT)初治患者预后的影响.方法收集北京协和医院1980年6月-2003年6月收治的127例MOGCT患者的临床病理资料,分析其初治时的手术方式与预后的相关性.结果 127例患者中,行全面分期手术者45例(35.4%),未行全面分期手术者82例(64.6%);术后残余瘤直径<2cm(即手术彻底)者71例(55.9%),直径≥2 cm(即手术不彻底)者11例(8.7%),不详者45例(35.4%);采用顺铂+长春新碱+博莱霉素(PVB)或博莱霉素+足叶乙甙+顺铂(BEP)方案化疗者75例(59.1%),长春新碱+阿霉素+环磷酰胺(VAC)方案化疗者18例(14.2%),未化疗或行其他方案化疗者34例(26.8%).随访期(2～254个月)内,行全面分期手术者复发率为16%(7/45),未行全面分期手术者复发率为61%(50/82),两者比较,差异有统计学意义(P<0.05).多因素分析结果显示,全面分期手术不影响无瘤生存时间(P=0.061),化疗方案、手术彻底性是明显影响无瘤生存时间的因素(P<0.05).行全面分期手术者随访2～158个月,死亡率为7%(3/45),未行全面分期手术者随访4～254个月,死亡率为15%(12/82),两者比较,差异无统计学意义(P>0.05).全面分期手术不影响长期生存时间(P>0.05),化疗方案、手术彻底性明显影响长期生存时间(P<0.05).结论手术彻底和规范化疗明显影响MOGCT初治患者的预后,而是否实施全面分期手术对初治患者预后无明显影响.

Objective To evaluate the impact of comprehensive staging surgery on relapse and survival of malignant ovarian germ cell tumor （MOGCT）. Methods The clinical data of 127 MOGCT cases treated in Peking Union Medical College Hospital from June 1980 to June 2003 were analyzed retrospectively. All the data about comprehensive staging surgery during primary surgery were collected, and other factors related to prognosis were also collected at the same time. COX model was applied in multivariate analysis related to relapse and survival. Results Among 127 patients, 45 （35.4%） received comprehensive staging surgery. Seventy-one cases （ 55. 9% ） received satisfied cytoreduction with residual tumor 〈 2cm, 11 cases （8. 7% ） with residual tumor ≥ 2 cm, and another 45 cases （35.4%） were undetermined. Seventy-five cases （59. 1% ） received cisplatin, etoposide, and bleomycin （BEP） or cisplatin, vinblastin, and bleomycin （PVB） chemotherapy, 18 cases （14. 2% ） received vincristine, actinomycin D, cyclophosphamide （VAC） chemotherapy, and 34 cases （26. 8% ） received other regimens or no chemotherapy. During the follow up period, 7 of 45 patients relapsed in patients who received compressive staging surgery, while the latter was not a significant factor （ P = 0. 061 ） . Chemotherapy regimen and residual tumor were the significant factors related to the relapse （ P 〈 0. 05 ）. All the patients were followed up for 2-254 months. Chemotherapy regimen and residual tumor were also the significant factors related to survival（P 〈0. 05 ）. Compressive staging surgery showed no significant effect on survival （P 〉0. 05 ）. Conclusions The critical treatment for MOGCT is satisfactory cytoreduction surgery plus standard chemotherapy. Comprehensive staging surgery shows no significant impact on the prognosis of MOGCT patients.