卵巢恶性生殖细胞肿瘤预后及生育状况分析

Prognosis and Reproductive Outcomes in Women with Malignant Ovarian Germ Cell Tumors

目的:探讨卵巢恶性生殖细胞肿瘤(MOGCTs)的临床特点、5年累积生存率以及行保留生育功能手术及化疗后患者的月经及生育状况。方法:采用回顾性分析法对我院1999年5月至2009年10月收治的34例MOGCTs患者的临床资料进行分析。结果:患者发病中位年龄28.5岁,34例患者中行根治性手术13例,行保留生育功能手术21例。单纯无性细胞瘤7例,非无性细胞瘤27例。26例患者术后补充化疗,其中行保留生育功能手术并化疗18例。化疗以博来霉素+依托泊苷+顺铂方案(BEP方案)及顺铂+长春新碱+博来霉素方案(PVB方案)为主。共随访9～146月,平均随访53.7±37.3月,失访4例,死亡3例,5年累积生存率为89%。临床观察指标中仅组织学分级为Ⅰ级的患者5年累积生存率(100%)高于Ⅱ～Ⅲ级(73%),差异有统计学意义(P=0.02),而各种手术类型、手术病理不同分期和不同组织学类型间的比较,差异均无统计学意义(P>0.05)。18例保留生育功能患者化疗后,月经异常发生率为83.3%(15/18),化疗结束后2～4月开始逐渐恢复。有生育计划的6例患者,共获得妊娠4例,其中3例自然妊娠,1例助孕后妊娠,共娩出健康新生儿3例。结论:MOGCTs总体预后较好,PVB、BEP方案是有效的化疗方案,化疗对行保留生育功能治疗患者卵巢功能的影响是可逆的,对于有生育要求的患者可行保留生育功能治疗并获得满意妊娠。

Objective： To explore the clinico-pathological features, five-year cumulative survival rate of malignant germ-cell tumors （ MOGCTs）, and reproductive outcomes and menstrual function of MOGCTs pa- tients who took fertility-sparing surgery and postoperative chemotherapy. Methods：The clinical data of 34 patients of MOGCTs who were treated in our hospital from May 1999 to October 2009 were retrospectively analyzed. Results：The mean onset age of patients with MOGCTs was 28.5 years old. Among 34 patients of MOGCTs, 13 patients took radical surgery while the others took fertility-sparing surgery; the histological type of 7 patients was pure dysgerminoma, the histological type of other 27 patients was non- dysgermi- noma. 26 patients （76.5%） were treated with chemotherapy postoperatively, among whom 18 patients took fertility-sparing surgery. The most common chemotherapy protocols were BEP （bleomycin, etoposide and cisplatin） and PVB（bleomycin, vincristine and cisplatin）. All patients were followed-up for 9 to 146 months, and the mean follow-up time was 53.7 ~37.3 months, 4 patients were lost to follow-up ,3 patients died of the disease, the five-year cumulative survival rate was 89%. The five-year Cumulative survival rate was signifi- cantly related to the histological grade（100% for grade I vs 73.0% for grade II -III, P =0.02）. There was no significant relationship between the other clinical factors （including operative type, surgical pathological stage, and histologic type） and five-year cumulative survival rate （ P 〉 0.05）. Among 18 patients who took fertility-sparing surgery and postoperative chemotherapy, the occurrence of menstrual disturbances was 83. 3% （15/18） ,however, all the patients recover menstruation 2 -4 months after chemotherapy. Among the 6 MOGCTs patients desiring pregnancy, 4 patients had pregnancies, 3 patients had natural pregnancies, onepatient had pregnancy after in-vitro fertilization, resulting in 3 live births. Conclusions： Malignant ovarian germ cell tumors have a good prognosis. The chemotherapy protocols BEP（bleomycin, etoposide and cispl- atin） and PVB（bleomycin, vincristine and cisplatin） are effective against MOGCTs. The impacts of chemo- therapy to the ovarian function of MOGCTs patients who treated with fertility-sparing surgery and adjuvant chemotherapy is reversible. The MOGCTs patients desiring pregnancy can have pregnancy after taking fertil- ity-sparing surgery and postoperative chemotherapy.