Analysis of outcomes and prognostic factors after fertility-sparing surgery in malignant ovarian germ cell tumors
Analysis of outcomes and prognostic factors after fertility-sparing surgery in malignant ovarian germ cell tumors
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DOI：
10.1016/j.ygyno.2017.03.023
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发表时间：
2017-06-01
影响因子：
4.7
通讯作者：
Nam, Joo-Hyun
中科院分区：
文献类型：
--
作者：
Park, Jeong-Yeol;Kim, Dae-Yeon;Nam, Joo-Hyun
Objective.评价早期和晚期卵巢恶性生殖细胞肿瘤（MOGCT）患者行保留生育能力手术后的肿瘤学和生殖结局，并分析预后因素。这项研究包括171名接受生育保留手术的患者。数据来自患者的医疗记录。使用对数秩检验和考克斯比例风险模型进行生存分析。分析其生殖结局。在中位随访时间86个月（范围，9-294个月）期间，25例患者（14.6%）出现疾病复发，5例患者（2.9%）死于疾病。5年无瘤生存率（DFS）为86%，5年总生存率（OS）为97%。I期的5年DFS为84%，II-IV期为89%。I期和H-IV期的5年OS分别为99%和91%。在多变量分析中，卵黄囊肿瘤、不完全分期手术和残留肿瘤是DFS降低的独立危险因素，卵黄囊肿瘤和残留肿瘤是OS降低的独立危险因素。月经规律者占85.5%，月经不调者占9.7%，绝经早者占4.8%。20例患者尝试妊娠，15例（75%）成功妊娠21次，13例（65%）产下20名健康婴儿。保留生育力的手术在患有MOGCT的年轻女性中具有极好的生存结局，即使是在晚期。生殖和产科成果令人鼓舞。卵黄囊肿瘤、手术分期不全、肿瘤残留是独立的预后因素。(C)2017爱思唯尔公司All rights reserved.
Objective. To evaluate the oncologic and reproductive outcomes and to analyze prognostic factors after fertility-sparing surgery in patients with early and advanced malignant ovarian germ cell tumors (MOGCTs).Methods. This study included 171 patients who underwent fertility-sparing surgery. Data were gathered from patients' medical records. Survival analysis was performed using the log-rank test and Cox's proportional hazards model. Reproductive outcomes were analyzed.Results. Twenty-five patients (14.6%) had recurrent disease, and five patients (2.9%) died of disease during the median follow-up time of 86 months (range, 9-294 months). The 5-year disease-free survival (DFS) was 86%, and the 5-year overall survival (OS) was 97%. The 5-year DFS was 84% for stage I and 89% for stage II-IV. The 5-year OS was 99% for stage I and 91% for stage H-IV. In multivariate analysis, yolk sac tumor, incomplete staging surgery, and residual tumor were independent risk factors for reduced DFS, and yolk sac tumor and residual tumor were independent risk factors for reduced OS. Reproductive and obstetric outcomes were evaluable in 124 patients, and 106 patients (85.5%) had regular menstruation, 12 patients (9.7%) had irregular menstruation, and six patients (4.8%) had premature menopause. Twenty patients tried to conceive, 15 patients (75%) succeeded in achieving 21 pregnancies, and 13 of the patients (65%) gave birth to 20 healthy babies.Conclusion. Fertility-sparing surgery has excellent survival outcomes in young women with MOGCTs, even in advanced stages. Reproductive and obstetric outcomes were promising. Yolk sac tumor, incomplete surgical staging, and residual tumor were independent prognostic factors. (C) 2017 Elsevier Inc. All rights reserved.