| Objective:Malignant ovarian germ cell tumor often occurs in young females.In recent years,with the improvement of surgical methods and the application of combined adjuvant chemotherapy,the survival rate and fertility prognosis has been greatly improved.In this study,we will respectively analysize the factors that affect the prognosis and assess the value of fertility-sparing surgery of 72 malignant ovarian germ cell tumors.Methods:We collected the medical records,pathologic type and follow-up information of ovarian malignant germ cell tumor patients treated in Qilu Hospital of Shandong University from January 2005 to June 2016.We conducted follow-up telephone interview and analyzed the treatment conditions respectively.Statistical analysize was performed using SPSS 22.0 software and survival analysis was performed by Kaplan-Meier method.The survival curve was calculated by log-rank method and the pregnancy rate was compared in Fisher exact test and ?2 test.P<0.05 was statistically significant.Results:1.The 72 MOGCT patients were aged from 1 year and 1 month to 68 years.The mean age is 22.96±12.13 year and the median age is 22 year.Patients were mostly hospitalized for abdominal distension or abdominal pain(48.6%)and abdominal mass(27.8%).54 cases were detected of serum CA-125 and 36 cases had their markers levated which including 16 cases of immature teratoma and 12 cases of yolk sac tumors;35 cases were detected of serum CA-199 and 11 cases had their markers levated which including 9 cases of immature teratoma;65 cases were detected of serum AFP and 40 cases had their markers levated which including 19 cases of immature teratoma and 18 cases of yolk sac tumors.2.All of the 72 patients had underwent sugery therapy which include 62 cases of fertility-sparing surgery.There were 16 cases underwent comprehensive staging sugery(ipsilateral ovarian salpingectomy + contralateral ovarian biopsy + pelvic lymph node dissection + omentum resection + appendectomy + suspected biopsy),25 cases underwent uncomprehensive staging surgery,15 cases underwent ovarian tumor removal surgery and 6 cases underwent ipsilateral ovarian salpingectomy surgery.3.Of the 72 patients with MOGCT who underwent adjuvant chemotherapy in 59 patients.Patients who received less than 4 courses were 23 and less than 6,more than 4 were 18.Most of patients were treated with chemotherapy regimen of PEB(cisplatin + etoposide + bleomycin)(76.3%).Otherwise,there are few of children were treated with chemotherapy regimen of AVCP(adriamycin + vincristine+ cyclophosphamide + cisplatin).4.Among the 72 patients,49 cases were stage I,7 cases were stage ?,11 cases were stage III and 2 cases were stage IV and the stage of other 3 cases was unkown.The 5-year survival rate of MOGCT in stage I was 96.7%and was 55.5%in stage II-IV.The difference is significant(P<0.001).The 5-year survival rate was 60.2%in patients with endodermal sinus tumor and 94.5%in patients with non-endodermal sinus tumor,the difference was statistically significant(P = 0.006);For patients with postoperative adjuvant chemotherapy,the 5-year survival rate was 88.6%,and the 5-year survival rate was 60.0%for patients without postoperative adjuvant chemotherapy.There was significant difference(P = 0.035).There was no siginificant difference between patients with comprehensive staging surgery or not and with ascites or not(P = 0.226,P = 0.562).5.At the end of the follow-up(6-137 months),6 patients relapsed,6 patients died.The 18 cases who had fertility plan,had pregnant for 17 times,term producted for 10 times,miscarriage for 6 times and 1 case is in gestation now.The pregnancy rate was 85.7%in the FIGO stage I and 25.0%in the FIGO stage ?-?.The difference was statistically significant(P = 0.042);There was no siginificant difference between aceeptted comprehensive staging surgery or not,with chemotherapy or not,and pathological types(P=0.225.P>0.05.P=0.154).Conclusion:1.MOGCT often occurrs in young women.The common clinical symptoms include abdominal pain,abdominal distension and pelvic mass,accompanied by CA-125 and other tumor markers increased.2.The prognosis of patients with FIGO stage I is significantly better than that of patients with stage II-IV,and the prognosis of yolk sac tumor is worse.Postoperative adjuvant chemotherapy can significantly improve the prognosis of patients.3.Fertility-sparing surgery is feasible for young patients.FIGO staging early pregnancy outcome is better than advanced patients.Histological type,acceptted comprehensive staging surgery or not,postoperative adjuvant chemotherapy has no significant effect for pregnancy outcome. |
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