Malignant Ovarian Germ Cell Tumors Retained Surgical Clinical Evidence-based Study Reproductive Function

Objective: to analyze the malignant ovarian germ cell tumors (MOGCT) of clinicalpathology, treatment and prognosis, surveyed the child birth of fertility-sparing group.Methods: Retrospected the clinical features, treatment and follow-up data of106cases ofMOGCT patients treated in Woman tumor division of Guangxi medical university affiliatedtumor hospital from January1,1986to December31,2010. Used Kaplan-Meier andLog-rank test statistical methods to calculate and compare progression-free survival andoverall survival between fertility-sparing group and not fertility-sparing group, and theirrecurrence rate are compared. Results: The median age was22(9-61)years old, pathologicalcategory included13dysgerminoma,36immature teratomas,49yolk sac tumor,4mixedgerm cell tumors,3embryonal carcinoma,1choriocarcinoma. fertility-sparing surgeryperformed on60cases, radical surgery performed on46cases.94patients receivedpostoperative adjuvant chemotherapy.With a median follow-up time56.5(2-309) a month,11cases were relapsed,23cases were died.The difference of overall survival time andprogression-free survival time between fertility-sparing group and not fertility-sparing grouphad no statistical significance(P>0.05),and the difference of recurrence rate between the twogroup had no statistical significance(P>0.05). Conclusion:MOGCT could achieve excellentprognosis after surgery and chemotherapy. Fertility-sparing surgery had no effect on thelong-term survival. Objective: To evaluate the prognosis related factors of fertility-sparing surgery inmalignant ovarian germ cell tumors. Methods: Retrospected the clinical data and follow-upresults of malignant germ cell tumor (MOGCT) patients with fertility preservation inGuangxi Medical University Affiliated Tumor Hospital, from January1,1985to December31,2010. Used Kaplan-Meier described survival curves. A univariate analysis using the Log-ranktest evaluated possible associations between survival and disease covariates. The multivariateanalysis was performed using the Cox proportional hazard regression. Logistic regressionanalysis was used to discuss the influence of different factors for the fertility. Results: Therewere60cases of MOGCT patients with a median age of20(9-34) year,12dysgerminoma,18immature teratomas,26yolk sac tumor,2mixed germ cell tumors,3embryonal carcinoma.The median follow-up time was41.5(2-237) months, recurrence occurred in4cases,9casesdied.31patients had a full-term pregnancy and33healthy babies were born. A univariateanalysis showed that pathological type, residual size, chemotherapy, the opposite ovarianbiopsy， lymph resection, omentum majus resection were unrelated to the prognosis.Multivariate analysis showed that only the postoperative residual tumor size effect on overallsurvival. The pathological types, opposite ovarian biopsy，comprehensive staging surgery,chemotherapy regimens and course of treatment showed no obvious effect on fertility.Conclusion: Postoperative residual tumor size can affect MOGCT patients’ progression-freesurvival and overall survival. Comprehensive staging operation had no obvious improvementon the prognosis of patients. MOGCT patients after fertility sparing surgery achieved anexcellent outcome. Most patients can have ovarian preservation after treatment. Objective：To evaluate the survival rate, recurrence rate and postoperative pregnancyafter fertility preservation operation in patients with malignant ovarian germ cell tumor.Methods：We searched for studies in MEDLINE and VIP database, retrospective case controlstudy which conformed to the standards was included and finished quality evaluation. Thehomogeneity study used RevMan5.1software for Meta analysis. Results：We identified11retrospective case control trial，which described fertility preservation operation and radicaloperation in malignant ovarian germ cell tumor and compared their survival. The Metaanalysis results: patients with malignant ovarian germ cell tumors after fertility-sparingsurgery had a better survival rate than the radical operation ones, the difference wasstatistically significant (OR=1.88,95%CI was1.32~2.69, P=0.0005). Malignant ovariangerm cell tumors with preservation of fertility with lower recurrence rate than patients not topreserve fertility operation, the difference was statistically significant (OR=0.11,95%CI was0.03-0.38, P=0.0007). Only4clinical case studies detailed record and analyzed the numberof patients who trying to get pregnant and actual successful pregnancy, and calculate the totalpregnancy rate was86.7%. Conclusion：Preserve fertility operation did not reduce thesurvival rate of patients with ovarian malignant germ cell tumor, could maintain thereproductive function and normal pregnancies, improved the quality of life of patients.