目的:我们提出了一项关于小儿卵巢未成熟畸胎瘤(ITs)的埃及研究,旨在阐明我们的治疗策略选择。
方法:对2008年至2023年在我们机构接受治疗的所有纯卵巢ITs儿童进行回顾性审查。分析包括临床特征,根据儿童肿瘤学组(COG)进行肿瘤分期,根据诺里斯系统评分,管理,和结果。
结果:包括32例患者,平均年龄为9岁。所有患者均接受初次手术。31例患者进行了单侧输卵管卵巢切除术。所有患者均完成手术分期。根据COG分期,有28例患者(87.5%)I期,1(3%)第二阶段,和3(9.5%)第三阶段。根据诺里斯的分类,16例(50%)患者被归类为I级,9(28%)二级,和7(22%)三级。所有Ⅰ期患者均采用单独手术治疗,而其余4人(12.5%)接受辅助化疗.5例I期患者患有腹膜胶质瘤病(GP),他们都没有接受过广泛的手术。在中位随访86个月时,两名患者出现事件.第一位患者(III期/I级)在手术床上出现IT复发,第二个(I期/I级)在对侧卵巢上有异时IT。两名患者均成功进行了手术,然后进行了二线化疗。所有患者的5年总生存率和无事件生存率分别为100%和93.4%,分别。
结论:单独手术策略和密切随访对儿童局部卵巢ITs取得了良好的结果,无论诺里斯分级或GP的存在。然而,对于未完全切除或局部晚期肿瘤的患者,辅助化疗值得怀疑。其作用需要通过具有更大样本量的前瞻性多中心研究进行进一步评估。
OBJECTIVE: We present an Egyptian study on pediatric ovarian immature teratomas (ITs), aiming to clarify our treatment strategy selection.
METHODS: A retrospective review of all children with pure ovarian ITs who were treated at our institution between 2008 and 2023. The analysis included clinical characteristics, tumor staging according to Children\'s Oncology Group (COG), grading based on the Norris system, management, and outcomes.
RESULTS: Thirty-two patients were included, with a median age of 9 years. All patients underwent primary surgery. Unilateral salpingo-oophorectomy was performed in 31 patients. Surgical staging was completed in all patients. Based on COG staging, there were 28 patients (87.5%) stage I, 1 (3%) stage II, and 3 (9.5%) stage III. According to Norris classification, 16 patients (50%) were classified as grade I, 9 (28%) grade II, and 7 (22%) grade III. All patients in stage I were treated using surgery-alone approach, whereas the remaining four (12.5%) received adjuvant chemotherapy. Five patients in stage I had gliomatosis peritonei (GP), and none of them underwent extensive surgery. At a median follow-up of 86 months, two patients had events. The first patient (stage III/grade I) developed IT relapse on the operative bed, and the second (stage I/grade I) had a metachronous IT on the contralateral ovary. Both patients were successfully managed with surgery followed by second-line chemotherapy. Five-year overall survival and event-free survival for all patients were 100% and 93.4%, respectively.
CONCLUSIONS: Surgery-alone strategy with close follow-up achieves excellent outcomes for localized ovarian ITs in children, irrespective of the Norris grading or the presence of GP. However, adjuvant chemotherapy is questionable for patients with incompletely resected or locally advanced tumors, and its role requires further evaluation through prospective multicentric studies with a larger sample size.