复发和未控卵巢恶性生殖细胞肿瘤保留生育功能的治疗

Preserve fertility in recurrent and uncontrolled malignant ovarian germ cell tumors

目的探讨复发和未控卵巢恶性生殖细胞肿瘤(MOGCT)的临床特征、挽救性治疗、预后,以及患者接受再次保留生育功能治疗的可行性。方法回顾性分析2000年1月1日至2017年3月31日期间收治的41例复发和未控MOGCT患者的临床资料。结果初次手术中保留生育功能治疗后MOGCT 41例中,复发患者18例(43.9%),未控患者23例(56.1%),6~37岁,根据2014年国际妇产科联盟(FIGO)手术病理或临床评估分期:Ⅰ期25例,Ⅱ期1例,Ⅲ期14例,Ⅳ期1例。未成熟畸胎瘤18例,卵黄囊瘤14例,无性细胞瘤1例,混合生殖细胞肿瘤8例。31例进行了保留生育功能的再次肿瘤细胞减灭术,8例进行了不保留生育功能的肿瘤细胞减灭术。失访2例,在复发后中位随诊30.3个月的随诊期内,再次复发13例(33.3%),死亡10例(25.6%)。复发后5年生存率和复发后无进展生存率分别为71.5%和68.7%。分期和复发后再次肿瘤细胞减灭术的手术满意程度是影响预后的独立因素(P=0.03;P=0.01)。结论 MOGCT初次规范治疗是减少复发和未控的关键。对于复发或未控M OGCT,满意的肿瘤细胞减灭术加标准的化疗对预后起着至关重要的作用。对年轻未生育患者可以考虑再次保留生育功能的挽救性治疗。

Objective To explore the clinical characteristics,salvage therapy and prognosis of recurrent and uncontrolled malignant ovarian germ cell tumor（M OGCT） and to evaluate the possibility of secondary fertility-sparing surgery. Methods The clinical data of 41 recurrent and uncontrolled M OGCT cases treated during Jan. 1 st,2000 and M ar. 31 st,2017 were retrospectively analyzed. Results There were 18 recurrent and 23 uncontrolled cases. The patients age ranged from 6 to 37 years. FIGO stage： stage I in 25 cases,stage II in 1 case,stage III in 14 cases,and stage IV in 1 case. There were 18 cases of immature teratoma,14 cases of yolk sac tumor,1 case of dysgerminoma and 8 cases of mixed germ cell tumor. Secondary fertility-sparing cytoreductive surgery was performed in 31 cases,and secondary cytoreductive surgery without fertility-sparing was performed in 8 cases. During the median follow-up of 30.3 months after recurrence,2 cases were loss to follow-up,13 cases（33. 3%） had a second relapse,and 10 patients（25.6%）died. The 5-year survival rate after recurrence was 68.7%,and the 5-year progress-free survival rate after recurrencewas 71.5%. FIGO stage and patients satisfaction with cytoreductive surgery were the independent prognostic factors（P0.05）. Conclusion The standardized primary therapy should be emphasized in the treatment of MOGCT. For recurrent and uncontrolled M OGCT,optimal cytoreductive surgery and adjuvant standardized chemotherapy have significant impacts on the prognosis of patients. For young nulliparous patients,secondary fertility-sparing salvage therapy can be taken into consideration.