| Background and ObjectiveMalignant ovarian germ cell tumor,(MOGCT) is a kind of female reproductivesystem malignant tumor, occurring often in young women. The contralateral ovary anduterus will be removed, while affected ones are removed during traditional radicaloperation, thus nulliparous women will completely lose the chance of fertility. Alongwith the development of platinum-based chemotherapy, MOGCT prognosis has beengreatly improved, fertility-sparing surgery is increasingly used, and achieved goodresults. Recently, fertility preservation has become one of the basic principles ofsurgical treatment of MOGCT patients. MOGCT patients, regardless what stages theyare at, as long as the contralateral ovary and uterus are not affected, can be carried outto preserve fertility, after being given adequate standard chemotherapy, most patientscan get a satisfactory outcome. This paper analyzes our hospital31MOGCT cases andsummaries the clinical characteristics, exploring the preserve fertility pregnancyoutcomes of different treatment modalities.Materials and Methods1. Clinical data:31cases MOGCT patients, of the First Affiliated Hospital ofZhengzhou University from June2004to June2012, all patients were firstdiagnosed as MOGCT, and were under the first treatment. All the operations werecarried out to preserve fertility, confirmed to have complications by pathologicaldiagnosis.2. Methods: The medical records, detailed records of the basic situation of enrolledpatients, FIGO stage, histological type of surgery, postoperative pathologicaldiagnosis, postoperative chemotherapy and recurrence in patients with secondarysurgery and so on. Reading follow-up medical records and telephone interviewswere also employed.3. Statistical analysis: Statistical analysis was performed using SPSS18.0software,and the survival rate is calculated with the Life-Table, survival analysis was contrasted by Kaplan-Meier. Pregnancy rates were compared in fourfold table.P <0.05difference bears statistically significance.Results1. Of31MOGCT patients, aged from8to36years old, with a medium age of19years old,28cases were under30years old,16cases were from10to20(51.61%,16/31). Clinical manifestations: chronic abdominal pain or bloating,12cases (38.71%,12/31), perceived abdominal mass,8cases (25.81%,8/31),abnormal vaginal bleeding,4cases (12.90%,4/31), examination discoverer3cases (9.68%,3/31), short-term weight loss and fatigue,1case (3.23%,1/31),acute abdomen as the first symptom,3cases (9.68%,3/31); dysgerminoma,8cases,14cases of immature teratoma, yolk sac tumor,7cases, malignant mixedgerm cell tumor,2cases. FIGO staging: Ⅰa,23cases, Ⅰc,3cases, Ⅱ,threecases, Ⅲ, two cases.28cases had tumor markers detection,4cases withimmature teratoma and two cases with yolk sac tumor had their CA125elevated,eight cases, AFP elevated, including six cases with yolk sac tumors, one case withimmature teratoma patients and one case with malignant mixed germ cell tumors.Four cases with elevated LDH were dysgerminoma patients.2. Of31patients,9had their ovarian cancer removed,14ones had their ovarianaccessories removed, and the other8ones were removed of ipsilateral accessories,contralateral ovarian biopsy, and(or) parts of contralateral ovary. Eight patientspreserved fertility while undergoing a comprehensive staging operation, of whomone was removed part of her bilateral ovaries, another was dissected of her aorticlymph node at the same time.23ones did not undergo comprehensive stagingoperation, only having their affected ovarian tumors or affected accessoriesresected.3. Twenty patients had postoperative chemotherapy;10ones experienced BEPprogram,7, routine PVB program,3, routine TP program. Of11patients,4werein dysgerminoma Ⅰa period,5were in immature teratoma Ⅰ a period, and thecytological grade were G1,1was of immature teratoma stage Ⅲ and1who wasstage Ⅰ a malignant and mixed germ cell tumor refused chemotherapy.5relapsed patients received second operation, one of whom was of stage Ⅲ with immature teratoma,1case of Phase Ⅱ of yolk sac tumor patient refusedchemotherapy, the other3patients underwent chemotherapy, of whom twoexperienced BEP program, and one PVB program.4. At the end of the follow-up (9to104months), of all the31patients, six relapsed,five-year survival rate was90%.1case of Phase Ⅱ dysgerminoma patientsrelapsed after27months, one case of stage Ⅲ Ⅰc relapsed after10months afterthe initial surgery and one case with immature teratoma, after18months. Onecase Ⅰ c and1case of Phase Ⅱ of yolk sac tumor relapse after12and14months respectively, one case ofⅠ a period of malignant mixed germ cell tumorrelapse after19months, five relapsed patients received secondary surgery. Onecase of immature teratoma stage Ⅲ Ⅱ stage patients and one case of yolk sactumor patients were8months after the second surgery,20months of death, theremaining three patients survived so far, one case of stage Ⅰ a malignant mixedgerm cell tumors patients relapse after surgery and chemotherapy in the secondrefusal five months after death, no death occurred in patients. Of twenty-twopatients who had family plan,14cases had pregnancy17times,13timesfull-term deliveries,2spontaneous abortions, two cases in pregnancy; amongpatients with ipsilateral ovarian pregnancy strip7, pregnancy in patients withipsilateral oophorectomy six times, ipsilateral oophorectomy+sectional view ofthe contralateral ovary biopsy (or)+partial resection in patients with contralateralovarian pregnancy1.8cases of non-pregnant patients, one case of hydrosalpinx,two cases of tubal fimbria adhesions, one case of ovulatory dysfunction, fourcases were infertile for unexplained reason5. The5-year survival rate of patients treated with chemotherapy (95%) higher thanthat of patients without chemotherapy (80%), the difference was statisticallysignificant (P=0.025). The5-year survival difference was not statisticallysignificant (P=0.112, P=0.301, P=0.189) between FIGO stage, histological typeand different surgical methods (whether comprehensive staging or not). FIGOstage Ⅱ+Ⅲ patients relapse rate is higher than stage Ⅰ (P=0.038), and therewas no significant difference in relapse rate (P=0.224, P=0.356, P=0.253)between pathological types, comprehensive staging and having chemotherapy or not.6. Patients of FIGO staging with stageⅠis higher than stageⅡ+Ⅲ in pregnancyrate (P=0.048), Ipsilateral ovarian tumors stripped ipsilateral oophorectomy,ipsilateral oophorectomy+cutaway contralateral ovary biopsy (or)+partialresection in patients with contralateral ovarian pregnancy rates were significantlydifferent (P=0.025), ovarian cancer patients with ipsilateral stripping easierpregnancy; pathological types, whether the pregnancy rate between chemotherapywas not significantly different (P=0.698, P=0.258).Conclusion1. MOGCT age to youth and women of reproductive age-based and pathologicaltypes are dominated by immature teratoma.2. Postoperative chemotherapy specification5-year survival rate is higher than inpatients without chemotherapy, and FIGO staging is another major factoraffecting recurrence.3. MOGCT pregnancy rate in patients with stageⅠ is higher than those in stageⅡ+Ⅲ, and Ipsilateral ovarian cystectomy conducive to pregnancy, and Postoperativechemotherapy had no effect on pregnancy. |
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