卵巢成熟性囊性畸胎瘤恶变的临床病理特征及预后分析

Clinical pathological characteristics and prognosis analyses of patients with malignant transformation of ovarian mature cystic teratoma

目的探讨卵巢成熟性囊性畸胎瘤恶变(malignant transformation in mature cystic teratoma of the ovary,MTMCTO)的临床病理特征、治疗方式及影响预后的相关因素。方法回顾2015年1月1日至2019年12月31日在四川大学华西第二医院接受治疗的18例MT-MCTO患者的临床病理及预后资料,结合文献复习,探讨该病的临床、病理特征,分析影响患者预后的相关因素。结果共纳入18例患者,发病时平均年龄48(19~74)岁,14例(77.8%)患者术前血清肿瘤标志物检测异常升高,其中12例(66.7%)患者糖链抗原19-9(CA19-9)升高(≥37.0kU/L)、2例(28.6%)患者术前影像学检查提示恶变可能性。15例(83.3%)患者行全面的分期手术,2例(11.1%)患者行保留生育功能的分期手术,1例(5.6%)患者因年龄大合并症多仅行子宫+双附件切除术。术后病理结果提示鳞癌9例(50.0%),黏液腺癌6例(33.3%),腺鳞癌1例(5.6%),透明细胞腺癌1例(5.6%),未分化多形性肉瘤1例(5.6%)。11例(61.1%)患者术后接受辅助化疗[博来霉素、依托泊苷、顺铂(BEP)或博来霉素、依托泊苷、顺铂/铂类联合紫杉醇(BEP/TP)方案]。平均随访时间57.4(49.3~65.4)个月,截止至2022年4月,平均无进展生存期(PFS)为63.0(48.9~77.1)个月,总生存期(OS)为63.5(49.9~77.1)个月,行肿瘤细胞减灭术的患者3年总体生存率显著低于行根治切除术组患者(0 vs.93.3%)。国际妇产科联盟(FIGO)ⅠC期及以上组3年总体生存率显著低于FIGOⅠA+ⅠB组(20%vs.100%)。结论MT-MCTO极其罕见,发病隐匿,术前血清肿瘤标志物尤其是CA19-9可能对其早期诊断有提示意义,患者的预后与FIGO分期密切相关。手术是MT-MCTO的核心治疗方式,但肿瘤细胞减灭术是否增加患者生存获益有待进一步研究。

Objective To investigate the clinicopathologic characteristics,treatment,and prognostic factors of malignant transformation in mature cystic teratoma of the ovary(MT-MCTO).Methods We performed a retrospective study of 18 patients with MT-MCTO who were admitted to the West China Second University Hospital from 2015 to 2019.The clinicopathological characteristics were studied and the factors related to the patient's prognosis were analyzed based on the clinicopathological and prognostic data and literature review.Results The average onset-age of patients with MTMCTO was 48(19-74)years.Preoperative serum tumor marker detection was abnormally high in 14 cases,among whom 12 patients had CA19-9≥37.0kU/L,and malignant changes were suggested in 2.Complete staging operations were performed in 15 cases.Two patients received fertility-preserving staging operation.One patient received only resection of uterine and bilateral appendix due to old age multiple complications.There were 9 cases of squamous carcinoma,6 cases of mucinous adenocarcinomas,1 case of clear cell adenocarcinoma,1 case of undifferentiated pleomorphic sarcoma,and 1 case of adenosquamous carcinoma.Eleven cases received adjuvant chemotherapy(BEP/TP).The average follow-up period was 57.4(49.3-65.4)months.By April 2022,the average cumulative PFS was 63.0(48.9-77.1)months,average cumulative OS was 63.5(49.9-77.1)months.Survival analysis demonstrated that the 3-year overall survival rate of cytoreductive surgery group was significantly lower than the radical surgery group(0 vs.93.3%,P<0.001),and that of FIGO stageⅠA-ⅠB group was higher that of the FIGO stageⅠC or greater group(100%vs.20%,P<0.001).Conclusions MT-MCTO is a rare malignancy which is usually hard to be diagnosed Serum tumor markers,specifically CA19-9 measurement,might be used as a diagnostic biomarker in MTMCTO.The patient's prognosis is closely related to FIGO staging.Surgical excision is the primary treatment for MTMCTO,but the survival benefits of cytoreductive surgery on MT-MCTO requires further study.