Fertility-preserving Treatment In Malignant Ovarian Tumors: Analysis Of58Cases

BackgroundIn recent years, malignant ovarian tumors tend to be found in younger people.When the diseases are diagnosed, quite a number of people has not yet complete thebirth. Besides, more people wish to have high living quality, so more and more peoplewant to preserve their reproductive functions. With the improvement of the operationmethod and the application of adjuvant chemotherapy, the prognosis of patients hasgreatly improved, which make it possible to retain patients’ reproductive function.Literature reported that after fertility-preserving therapy, the5-year survival rate of Istage borderline tumors can be as high as99%. The5-year survival rate of advancedborderline tumors can be65%to96%. The5-year survival rate of stage Ia or Icepithelial ovarian carcinoma can reach94~98%.The5-year survival rate of malignantovarian germ cell tumors who preserve fertility function was above90%. ObjectiveTo evaIuate the effects of fertility-preserving surgery and chemotherapy onfertility and ovarian function in patients with malignant ovarian tumors．MethodsTO retrospectively analyze clinical data of fifty-eight patients who receivedconservative treatments between2000and2012at the first affiliated hospital ofZhengzhou university. All the patient have complete follow-up data. The surgery,postoperative chemotherapy, postoperative menstruation and pregnancy outcomeswere analyzed, and compare the menstruation, sex hormone levels and pregnancyoutcomes between the chemotherapy group and nonchemotherapy group.ResultsAmong the fifty-eight patients，there were twenty-three cases of borderlineovarian tumors, six cases of sex cord stromal tumors. Five patients were epithelialovarian cancers. Twenty-four cases were malignant ovarian germ cell tumors. Theoperation methods are as follows: Seven patients received ovarian tumor resection.Forty-eight cases received bilateral adnexectomy. Three cases received unilateraladnexectomy and contralateral ovarian tumor resection. Among all thepatients,twenty-two cases received comprehensive staging surgery. Thirty-one casesreceived postoperative chemotherapy, the Chemotherapy regimens consist of PEBregimens, BVP regimens, PT/PC regimens and PAC regimens. By the end offollow-up, five cases relapse, including two deaths. There were thirty-five pregnancyin twenty-nine cases. All children are healthy and free from defects. Among thepatients who received postoperative chemotherapy, twelve patients experiencedamenorrhea after chemotherapy for one to four months. But when the chemotherapycompleted, the menstruation can recover. There were statistical significant differencein menstruation condition in the patients with or without chemotherapy(P<0.05).Serum FSH, LH levels rose and E2level declined during amenorrhea.The pregnancy rate of the patients who didn’t receive chemotherapy was higher than the cases whoreceived postoperative chemotherapy.Conclusion1. Fertility preserving surgery is safe and feasible for early stage malignantovarian tumors, especially the malignant germ cell tumors.2. Chemotherapy may have some reversible effect on ovarian function but haveno obvious teratogenic effect on their offsprings. Due to the small number of cases,this conclusion may have limitations.