卵巢支持间质细胞肿瘤保留生育功能治疗的预后及相关因素

Prognosis related factors of patients with ovarian Sertoli-Leydig cell tumor after fertility-preserving surgery

目的探讨卵巢支持间质细胞肿瘤(SLCT)患者保留生育功能治疗的预后及其相关因素。方法回顾性分析北京协和医院52例保留生育功能治疗的卵巢SLCT患者的生存率、复发、死亡与生育状况等。结果临床表现中,41例有高雄激素表现,11例无内分泌表现。全部肿瘤均位于单侧卵巢;肿瘤最大径线2~34 cm,平均10 cm;Ⅰ期50例(ⅠA期36例,ⅠC期14例),ⅢC期1例,分期不明1例;高分化4例(7.7%),中分化14例(26.9%),低分化34例(65.4%),低分化者中含有网状结构者9例、含异源成分者4例。初次手术方式包括仅行肿瘤剔除6例(11.5%),患侧附件切除36例(69.2%),全面分期手术10例(19.2%)。初治术后29例接受化疗1~4个疗程。平均随访72个月,6例复发,3例死亡。预后差与无内分泌表现、肿瘤大、分期高于ⅠA期有关,与低分化、网型或异源成分可能相关,与手术方式及术后是否化疗无关。结论卵巢SLCT是一种少见的卵巢性索间质肿瘤,多数患者以男性化临床表现和盆腔包块为特征,无内分泌表现者恶性程度较高,预后与肿瘤大小、临床分期有关,与组织分化程度可能相关。年轻患者可采取保留生育功能的手术,对有高危因素及复发患者建议术后辅助化疗并长期随访。

Objective To evaluate the prognosis and its related factors of patients with ovarian Sertoli-Leydig cell tumor（SLCT） after fertility-preserving surgery. Methods Detail clinical data,including survival rates,recurrence,death and fertility states,of 52 SLCT patients after fertility-preserving surgery in Peking Union M edical College Hospital were retrospectively reviewed. Results Forty-one cases showed androgenic manifestations,while 11 cases had no endocrine symptoms. All tumors located in unilaterl ovary; the mean tumor diameter was 10.0 cm（range 2-34 cm）; fifty cases were at stage Ⅰ（36 cases at stage ⅠA,14 cases at stage ⅠC）,one was at stage ⅢC,ones stage was unknown; four（7.7%） tumors were well differentiated,14（26.9%） were intermediately differentiated,34（65.4%） were poorly differentiated. In the poorly differentiated tumors,9 had a retiform pattern,4 had heterologous elements. Six patients（11.5%） underwent cystectomy,36（69.2%） underwent unilateral salpingo-oophorectomy,and 10（19.2%） underwent standard staging surgery. Twenty-nine patients received systematic chemotherapy（1-4 courses of treatment） afterthe initial surgery. The average follow-up period was 72 months; six cases recurred,in whom 3 cases died. The poor prognosis was correlated with no endocrine symptoms,bigger tumor size,clinical stage ⅠA,and probably correlated with poor differentiation,retiform pattern and heterologous elements,while not correlated with surgery type and postoperative chemotherapy. Conclusion SLCT is a rare type of sex cord-stromal tumor of the ovary. M ost SLCT patients have androgenic manifestations and abdominal masses,and tumors without endocrine changes may indicate more aggressive biological behaviors. The prognosis is correlated with tumor size and clinical stage,and probably correlated with the degree of differentiation. Conservative surgery is acceptable for young patients wishing to preserve fertility,and postoperative adjuvant chemotherapy and long-term followup are recommended to those with high-risk factors of recurrence.