| Objective:Malignant ovarian germ cell tumors(MOGCTs)are a group of ovarian malignancies with good prognosis.The aim of this study was to analyze the clinical characteristics of MOGCTs,to explore the factors that influence prognosis,and to investigate the clinical application and value of cystectomy in patients with early MOGCTs.Methods:1.The clinical and follow-up data of 63 patients with MOGCTs between January 2004 to February 2017 were analyzed retrospectively.The morbidity characteristic,pathology,clinical stage,surgical method,adjuvant chemotherapy,survival and fertility outcomes were sorted out to analyze the relationship between clinical features and prognosis.2.To analyze the clinical characteristics,adjuvant therapy,survival and fertility outcomes of 22 patients who underwent cystectomy,then evaluate the clinical value of cystectomy in early MOGCTs.Results:1.The median age of 63 MOGCTs was 24 years,53(84.1%)in the han nationality,and 10(15.9%)in the minorities.The main clinical manifestations inclued chronic abdominal pain,abdominal bloating,abdominal mass,menstrual disorders,acute abdominal disease or compression symptoms.Pathological types included 35(55.6%)immature teratomas,10(15.9%)dysgerminoma,8(12.7%)malignant mixed germ cell tumors,5(7.9%)yolk sac tumor,4(6.3%)ovarian mature teratoma with malignant transformation and 1(1.6%)ocarcinoid tumor with ovarian germ cell origin.According to the FIGO 48 cases(76.2%)presented with stage I;3 cases(4.8%),stage?;9 cases(14.2%),stage ?;3 cases(4.8%),stage ?.All patients underwent surgical treatment.Fertility-sparing surgery performed on 48(76.2%)cases,radical surgery performed on 12(19.0%)cases and 3 cases(4.8%)only performed biopsy.32 cases received adjuvant chemotherapy,the main chemotherapy regimen is BEP(Bleomycin,Etoposide,Cisplatinum).The follow-up period was 2-150 months and the median follow-up was 31 months.Of the 63 patients,5 cases lost follow-up,8 cases were tumor persistence,1 case had recurrence and 14 cases died.The 5-year survival rate were 77.8%.8 patients with fertility plan had natural pregnancy 6 times,full-term delivery of healthy newborns in 5 cases and 1 case is currently in pregnancy.2.A univariate analysis showed that nationality,staging and standardized chemotherapy may be associated with prognosis(P<0.05);fertility-sparing surgery group VS non-fertility preservation group was found to be no significantly correlation with the prognosis of MOGCTs(P>0.05).The results of multivariate analysis further confirmed that staging was an independent prognostic factor for MOGCTs(P<0.05),there was no significant difference in the prognosis of the patients who had fertility-sparing surgery and non-fertility preservation surgery(P>0.05).3.Of 22 MOGCTs patients who underwent cystectomy,with a medium age of 26 years old,16 cases(72.7%)were childless before surgery.Pathological type:19(86.4%)with immature teratoma(16 of G1,2 of G2 and 1 of G3),1 with dysgerminoma,1 case of carcinoid tumor with ovarian germ cell origin,1 case of ovarian mature teratoma with malignant transformation.All cases were stage ?:la,17(77.3%)cases;Ic,5(22.7%)cases.After primary surgical treatment,1 case of stage la G2 immature teratoma patients choose secondary surgery(affected side salpingo-oophorectomy),5 patients(1 with immature teratoma,stage Ia G3;1 with dysgerminoma,stage Ic2;1 of carcinoid tumor with ovarian germ cell origin,stage Ia;2 with immature teratoma,stage la G1)received BEP regimen adjuvant chemotherapy,1 case of stage Ic2 G2 immature teratoma did not follow the doctor to return to hospital chemotherapy,the remaining 15 patients chose close follow-up.Follow-up was available for all the patients,with a median duration of 31.5 months.During the follow-up period,1 patient who underwent secondary surgery appear tumor evidence again after four mounths of the affected side salpingo-oophorectomy.By cytoreductive surgery and 8 cycles BEP chemotherapy,to achieve complete remission(CR).1 patients with stage Ic2 G2 immature teratoma,who did not return to hospital for treatment,found tumor progression after 3 months.After 1 cycle of BEP chemotherapy and secondary cytoreductive surgery,she chose withdrawing treatment due to personal economic reasons,died in 5 months after secondary surgery.4 patients had natural pregnancy 4 times,full-term delivery of healthy newborns in 3 cases and 1 case is currently in pregnancy.Conclusions:1.MOGCTs is a group of ovarian malignancies with good prognosis,the majority of patients with early stage at the time of initial diagnosis.It is necessary and feasible to carry out the fertility-sparing surgery for patients with fertility requirements.2.Staging was the independent prognostic factor for MOGCTs.3.For MOGCTs with clinical stage ?,especially the G1 immature teratoma,cystectomy followed by necessary adjuvant chemotherapy appeared satisfactory.Stage ? G2/G3 immature teratoma,adjuvant chemotherapy is recommended after cystectomy. |
PDF Full Text Request