| Objective: To analyze the clinicopathological feather of 39 patients with malignant ovarian germ cell tumors retrospectively, and analyze the main prognosis factors of malignant ovarian germ cell tumors and evaluate the influence ofmenstruation and pregnant outcome in patients with fertility-sparing operation combined with chemotherapy. The value offertility-sparing operation ofpatients with MOGCT is investigated at last.Methods: Retrospective analysis of the with general clinical data, such as age, clinical symptom, histological grade, FIGO- stage, the serum tumor markers level, operation and chemotherapy, the prognosis, influence of menstruation and pregnant outcome after operation and chemotherapy.Results:1. 44 patients included in this study from Jan 1999 to Nov 2009, age range 10-60 years, median age of 23 years, with 5 patients loss to follow-up. MOGCT occursin adolescence mainly, in the reproductive age partly, in postmenopausal age occasionally.2. The main clinical symptom included: abdominal mass(53.82%), abdominal distention, abdominal pain, vaginal bleeding.3. Histological grade included: 14 cases of dysgerminoma(35.9%), 10 cases of immature teratoma(25.6%), 9 cases of yolk sac tumor(23.1%), 5 cases of mixed malignantgermcell tumor(12.8%), 1 cases of embryonal carcinoma(2.6%).4. FIGO-stage(FIGO2013 years) included: 20 cases with I stage(51.28%); 5 cases with stage II(12.82%); 12 cases with stage III(30.77%); 2 cases with stage IV(5.13%).5. Preoperative serum tumor markers as below: 29 cases were abnormal among 39 cases, 9 cases(31.03%) were normal, 1 case unchecked. All patients with AFP elevated in yolk sac tumor, including 7 cases of elevated CA125; CA125, AFPand HCG elevated in embryonal carcinoma. Complex tumor marker results observed in dysgerminoma, immatureteratoma and mixed malignant germ cell cases with single marker raised or multiple makers raised or normal marker.6. Operative methods: fertility-sparing operation performed in 33 cases(84.6%).fertility-sparing operation not performed in6 cases(15.4%) included: 5 cases with comprehensive staging operation, 1 case with debulking surgery.7. Postoperative chemotherapy: 33 cases received the postoperative chemotherapy.BEP(belymycin, etoposide and cisplatin) was the main regimen. While the 6 cases with Staging Ia did not receive the chemotherapy(fertility-sparing operation performed)8. Survival prognosis: 8 cases died among 39 patients until on 30 Nov 2014,accounting for 20.5%. Till of the date the final follow-up, 31 patients with tumor-free survival, accounting for 79.5%. 4 cases died among 33 cases performed fertility-sparing operation, and 5-year survival rate was 87.9%; four cases died among6 cases performed comprehensive stage or debulking surgery, and 5-year survival rate was 33.3%.9. Two cases werepre-menarche among 27 cases who received fertility-sparing operation and postoperative adjuvant chemotherapy, 22 of 25 patients during chemotherapy(88%) menstrual abnormalities, including 20 cases of amenorrhea(80%) and 2 cases oligomenorrhea(8%). normal menstruationrecovered after three months of post-chemotherapy in these cases, the two pre-menarche cases have normal menstruation now, no premature ovarian failure casesappeared.10. Analysis of pregnant outcomes: 8 cases werepregnant among 14 uncontraceptional patients with requirements of fertility, the pregnant rate was 57.1 %.8 cases in pregnant group, six cases in non-pregnant group. There were no statistical differences between the two groups compared to the age, FIGO staging, surgical approach(open or laparoscopic surgery) and regimens of chemotherapy. 8 cases in the pregnancy group were natural conception.In the early pregnancy, there were no embryonic death, no signs of abortion during pregnancy, no gestational hypertension and no other obstetric complications.7 cases who received the chemotherapy,childbirth 9 times, full-term delivery 7 times, premature birth 2 times. There were2premature rupture of membranes cases and 1 fetal growth restriction case. One case without chemotherapy was full-term delivery.Conclusions:1. FIGO stage,histological type of malignancy and ascites are the main prognostic factors of patients. The poor prognosis is in patients with late-FIGO staging,embryonal carcinoma or maligant ascites. There is no significant prognostical difference between dysgerminoma and non-dysgerminoma, maybe due to small sample size and the late-FIGO staging of the non-dysgerminoma tumors.2. Most patients of MOGCTs with fertility-sparing operation had pregnancy naturely after one year of chemotherapy and pregnant outcomes were satisfied.There were no effect on pregnant outcome in age, FIGO stage(Stage Ia, Stage Ib),surgery approach and chemotherapy of patients. |
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