卵巢颗粒细胞瘤预后影响因素的分析

Prognostic Factors in Granulosa Cell Tumor of the Ovary

目的 探讨卵巢颗粒细胞瘤临床、病理因素对预后的影响。方法 回顾性分析我院195 8年至 1995年收治的 10 0例卵巢颗粒细胞瘤患者的年龄、临床分期、核分裂相及早期患者的治疗方法选择等因素与预后的关系 ,并对复发与未复发患者 ,近期复发 (<10年 )与远期复发 (≥ 10年 )患者进行比较。结果 全组总的 5年和 10年生存率分别为 80 %和 72 %。不同年龄患者 (≥ 40岁 ,<40岁 )的 5年和 10年生存率 ,分别比较 ,差异无显著性 (P >0 0 5 )。临床分期为Ⅰ期者 5年和 10年生存率分别为 98%和 96 % ,Ⅱ期分别为 70 %和 6 0 % ,Ⅲ～Ⅳ期均为 0 % ;外院治疗后复发或未控者 5年和10年生存率分别为 5 8%和 40 % ,分别比较 ,差异均有显著性 (P均 <0 0 5 )。 47例有核分裂相计数的患者中 ,核分裂相 <5 / 10高倍视野 (HPF)的 5年和 10年生存率均为 96 % ,而核分裂相≥ 5 / 10HPF者的 5年和 10年生存率分别为 5 8%和 36 % ,分别比较 ,差异均有极显著性 (P均 <0 0 1)。治疗方法不同 (包括单纯手术、手术 +化学治疗或放射治疗 )的 5 6例临床Ⅰ期患者 ,其 5年和 10年生存率比较 ,差异均无显著性 (P <0 0 5 )。全组 44例复发患者的中位复发时间为 5 3个月 ,其中 8例为远期复发(≥ 10年 ) ,最长复发时间为 2 5年。

Objective To study the effect of clinical and pathologic factors on prognosis for granulosa cell tumor of the ovary. Methods The clinical records and tumor sections of 100 patients with granulosa cell tumors of the ovary between 1958 and 1995 were reviewed. The relationship between age、stage、 mitosis and the adjuvant therapy for early stage (stage I) were analyzed retrospectively. Patients with recurrent tumors were compared with patients who remained without disease, patients with early recurring tumors were compared with late recurring tumors. Results The overall 5 and 10 year survival rates were 80% and 72%. There were no significant difference between ages and survival ( P> 0 05). The survival rates in stage Ⅰwere 98% and 96% after 5 and 10 years, respectively, and in stages Ⅱwere 70% and 60%,after 5 and 10 years, all of 4 patients with stage Ⅲ～ Ⅳ were dead of recurrent disease in 1 year. The frequency of observed mitosis influenced the survival rate: with less 5/10 high power fields (HPF) the survival were 96% both at 5 and 10 years, with more or equal 5/10 HPF the 5 and 10 year survival rates were 58% and 36%, respectively( P< 0 01). No significant correlation could be established between the adjuvant therapy and 5 and 10 years survival in 56 stage Ⅰ patients. There were 44 patients with recurrent disease in this group, median time to recurrence was 53 months. Late recurrence appeared in 8 cases. The significant differences in stage and abdominal mass were noted between the recurrent tumors and the group without disease ( P< 0 05). When early and late recurring tumors were compared, statistically significant differences were again noted: early recurring tumors had higher mitotic rates and late stage, and late recurring tumors had lower mitotic rages and early stage. Patients without recurrent tumors were similar to the patients with early recurring tumors. Conclusions Tumor stage and mitotic rate are the clinical and pathologic prognosticators in granulosa cell tumor. It is difficult to predict late recurrences using these clinical and pathologic parameters.