目的:描述目前1期恶性卵巢生殖细胞肿瘤的外科治疗和相关的肿瘤结局。
方法:我们对英国四个主要妇科肿瘤中心12年治疗的所有1期原发性卵巢生殖细胞肿瘤进行了回顾性研究。我们评估了手术路径,节省生育力的方法,单纯卵巢囊肿切除术,和手术分期,并将这些与临床结果相关。
结果:86例患者获得了中位4.4年的随访(IQR4.3)。中位年龄为26岁(范围11-47岁)。有24例(27.9%)无性细胞瘤,13例(15.1%)卵黄囊瘤,10例(11.3%)混合生殖细胞肿瘤,和39个(45.3%)未成熟畸胎瘤。总生存率为96.6%(OS,95%CI91.9-100%),无事件生存率为81.8%(EFS,95%CI72.5-92.3),5年。大多数人接受了保留生育能力的手术(93%,n=80)。在一部分未成熟畸胎瘤患者中,如果患者仅接受单侧膀胱切除术或输卵管卵巢切除术,其复发或生存率无显著差异.开腹手术是最常见的方法(n=66,76.7%),更常用于较大的肿瘤>10厘米。42例(48.6%)患者进行了手术分期程序,各组织学亚型的分期率无显着差异。11例(12.7%)进行腹膜活检,网膜评估40例(46.5%),淋巴结清扫术10例(11.6%)。在接受分期手术的患者之间,EFS没有显着差异(83%,CI71-98%)与那些没有(84%,CI72-98%)。在儿科(42.1%8/19)和成人(57.9%34/67)人群中,分期程序的比率没有显着差异。
结论:在所有组织学和年龄,在该队列中,没有手术分期对无病生存期或总生存期没有影响.这项研究还提高了卵巢囊肿切除术在未成熟畸胎瘤中的作用的可能性。这些发现值得在更大的前瞻性研究中进行调查。
OBJECTIVE: To describe the current surgical management of stage 1 malignant ovarian germ cell tumours and correlated oncological outcomes.
METHODS: We undertook a retrospective
study of all stage 1 primary ovarian germ cell tumours treated in four major UK gynaecology oncology centres over 12 years. We assessed route of surgery, fertility-sparing approaches, ovarian cystectomy alone, and surgical staging and correlated these with clinical outcomes.
RESULTS: Eighty-six patients were followed-up for a median of 4.4 years (IQR 4.3). The median age was 26 (range 11-47). There were 24 (27.9%) dysgerminomas, 13 (15.1%) yolk sac tumours, 10 (11.3%) mixed germ cell tumours, and 39 (45.3%) immature teratomas. Overall survival was 96.6% (OS, 95% CI 91.9-100%), with event free survival of 81.8% (EFS, 95% CI 72.5-92.3) at 5 years. The majority had fertility-sparing surgery (93%, n = 80). In a subset of patients with immature teratoma, there was no significant difference in recurrence or survival if patients underwent unilateral cystectomy only or salpingo-oophorectomy. Laparotomy was the most common approach (n = 66, 76.7%), used more frequently for larger tumours > 10 cm. Surgical staging procedures were undertaken in 42 (48.6%) patients with no significant difference in rates of staging across histological subtypes. Peritoneal biopsies were taken in 11 (12.7%), omental assessment in 40 (46.5%) and lymphadenectomy in 10 (11.6%). There was no significant difference in EFS between patients who underwent staging procedures (83%, CI 71-98%) versus those that did not (84%, CI 72-98%). There was no significant difference in the rate of staging procedures in paediatric (42.1% 8/19) and adult (57.9% 34/67) populations.
CONCLUSIONS: Across all histologies and ages, the absence of surgical staging did not impact upon disease free or overall survival in this cohort. This
study also raises the possibility of a role for ovarian cystectomy in immature teratoma. These findings warrant investigation in larger prospective studies.