| Objective:To explore the clinico-pathological features, five-year cumulative survival rate and prognostic factors of malignant germ-cell tumors (MOGCTs),and analyze the reproductive outcomes and menstrual function of MOGCTs patients who took fertility-sparing surgery and postoperative chemotherapy.Methods:The clinical data of38patients of MOGCTs who had been treated in our hospital from January2002to December2012were retrospectively analyzed.All patients were followed-up by telephone and letters. Survival and reproductive outcomes and menstrual function of MOGCTs patients were determined. To investigate the influence of age pathological type, surgical pathological stage, operative type, level of tumor marker and course of chemotherapy on the prognosis of MOGCTs. All data was statistically analyzed by SPSS19.0Soft ware. The Kaplan-Meier method was used for single variable data analysis. Differences of the survival rate were d using the log-rank test was used for determining the differences of the survival rate. The significance test level was P<0.05.Results:(1)The mean onset age of patients with MOGCTs was23.5years old.Pelvic mass (55.26%), abdominal pain (55.26%) and irregular menstruation(10.52%) are main clinical manifestations.(2)38patients were followed-up for2to130months,6patients died of the disease,5patients were lost to follow-up. The average survival time of the33patients was50.00±41.79months. The one-year,there-year and five-year cumulative survival rate was separately93.10%,77.27%and66.67%.(3)The average survival time of the younger group (≤40years old) was59.63±43.82months and the5-year survival rate was91.67%; while the average survival time of the older group (>40years old) was only24.33±21.11months and the5-year survival rate was16.67%. The difference between the survival rate of these two groups was significant (P=0.000), which suggested that younger patients have better prognosis than the older ones.(4) The average survival time of the patients who took fertility-sparing surgery was54.18±40.19months and the5-year survival rate was81.82%; while the average survival time of the patients who took radical surgery was51.13±49.91months and the5-year survival rate was60.00%. The average survival time of the patients who took palliative surgery was16.33±19.09months and the5-year survival rate was33.33%.The difference between the survival rate of these there groups was significant (P=0.008), which suggested that the patients who took radical surgery have better prognosis than the those who took palliative surgery.(5) The average survival time of the patients who took≥3courses chemotherapy was57.61±42.56months and the5-year survival rate was83.33%; while the average survival time of the patients who took<3courses chemotherapy was32.50±35.95months and the5-year survival rate was33.33%; The difference between the survival rate of these tow groups was significant (P=0.013), which suggested that the patients who took≥3courses chemotherapy have better prognosis than the those who took<3courses chemotherapy.(6)The histological type of9patients was pure dysgerminoma, and other29patients was non-dysgerminoma. The average survival time of the the first group was56.63±48.08months and the5-year survival rate was100%; while the average survival time of the the second group was47.88±40.44months and the5-year survival rate was62.50%. The first group have better prognosis than the second group. But the difference between the survival rate of these tow groups was not significant (P=0.174).(7)The average survival time of early stages (Ⅰ and Ⅱ) was51.69±43.09months and the5-year survival rate was76.92%; but the average survival time of advanced stages (Ⅲ) was only43.71±38.97months and the5-year survival rate was40.00%. The difference between the survival rate of these two groups was not significant (P=0.096).(8)23patients who took fertility-sparing were treated with chemotherapy postoperatively,3patients were lost to follow-up,the occurrence of menstrual disturbances was 20.00%(3/15),however,all the patients recover menstruation2-4months after chemotherapy.Among the20patients who are desiring pregnancy,6patients had8natural pregnancies,resulting in5live births.The pregnancy rate was40.00%(8/20).Conclusions:Pelvic mass and abdominal pain are the most common clinical manifestations of. Women of reproductive age have a higher prevalence.Malignant ovarian germ cell tumors have a good overall prognosis.Age and operative type and course of chemotherapy have influence on the prognosis of MOGCTs. Fertility-sparing surgery combined with postoperative chemotherapy as soon as possible is the key to cure the disease.The patients who took^3courses chemotherapy have better prognosis than the those who took<3courses chemotherapy.The prognosis of MOGCTs patients desiring pregnancy can have pregnancy after taking fertility-sparing surgery and postoperative chemotherapy can be significantly improved.Reproductive endocrine function of patients can be reserved and we can receive satisfactory pregnancy outcome.Pathological type, surgical pathological stage, tumor size and level of tumor marker have on influence on the prognosis of MOGCTs. |
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