■未成熟畸胎瘤是罕见的恶性卵巢生殖细胞肿瘤,通常诊断为年轻女性,保留生育能力的手术是首选治疗方法。辅助化疗在I期疾病中的作用仍存在争议。我们评估了监测与化疗对I期未成熟畸胎瘤复发率的影响。
我们在圣杰拉尔多医院收集了单中心回顾性系列的I期未成熟畸胎瘤患者,这些患者接受了保留生育功能的手术治疗,蒙扎,意大利,1980年至2019年。通过多因素logistic回归分析复发的潜在危险因素。
■在纳入的74名患者中,12%(9/74)接受化疗,而88%(65/74)接受了监测。中位随访时间为188个月。IA/IB期和IC未成熟畸胎瘤的复发无差异[10%(6/60)与28.6%(4/14)(P=0.087)],1级、2级和3级[7.1%(2/28)与14.3%(4/28)与22.2%(4/18)(p=0.39)],和监测与化疗组[13.9%(9/65)vs.11.1%(1/9))(p=1.00)]。在单变量分析中,术后入路对复发无影响.监测和化疗组的5年无病生存率分别为87%和90%,两组总生存率分别为100%.
■我们的结果支持在I期未成熟畸胎瘤中进行监测的可行性。辅助化疗可保留用于复发。然而,应该讨论化疗的潜在益处,尤其是高危肿瘤。前瞻性系列有必要证实我们的发现。
■到目前为止,对于辅助化疗在I期卵巢未成熟畸胎瘤中的作用尚未达成共识.一些研究表明,只有监测是可以接受的选择。然而,指南在这个主题上没有定论。
■监测组和辅助化疗组之间在复发方面没有观察到差异。所有复发患者均成功治愈,无疾病相关死亡。
■辅助化疗应与患者适当讨论。然而,根据我们的数据,它可能被保留用于复发。
UNASSIGNED: Immature teratomas are rare malignant ovarian germ cell tumours, typically diagnosed in young women, where fertility-sparing surgery is the treatment of choice. The role of adjuvant chemotherapy in stage I disease remains controversial. We evaluated the impact of surveillance versus chemotherapy on the recurrence rate in stage I immature teratomas.
UNASSIGNED: We collected a single centre retrospective series of patients with stage I immature teratomas treated with fertility-sparing surgery at San Gerardo Hospital, Monza, Italy, between 1980 and 2019. Potential risk factors for recurrence were investigated by multivariate logistic regression.
UNASSIGNED: Of the 74 patients included, 12% (9/74) received chemotherapy, while 88% (65/74) underwent surveillance. Median follow-up was 188 months. No difference in recurrence was found in stage IA/IB and IC immature teratomas [10% (6/60) vs. 28.6% (4/14) (P=0.087)], grade 1, grade 2, and grade 3 [7.1% (2/28) vs. 14.3% (4/28) vs. 22.2% (4/18) (p=0.39)], and surveillance versus chemotherapy groups [13.9% (9/65) vs. 11.1% (1/9)) (p = 1.00)]. In univariate analysis, the postoperative approach had no impact on recurrence. The 5-year disease-free survival was 87% and 90% in the surveillance and chemotherapy groups, respectively; the overall survival was 100% in both cohorts.
UNASSIGNED: Our results support the feasibility of surveillance in stage I immature teratomas. Adjuvant chemotherapy may be reserved for relapses. However, the potential benefit of chemotherapy should be discussed, especially for high-risk tumours. Prospective series are warranted to confirm our findings.
UNASSIGNED: To date, no consensus has been reached regarding the role of adjuvant chemotherapy in stage I immature teratomas of the ovary. Some studies suggest that only surveillance is an acceptable choice. However, guidelines are not conclusive on this topic.
UNASSIGNED: No difference in terms of recurrence was observed between the surveillance and the adjuvant chemotherapy group. All patients who relapsed were successfully cured with no disease-related deaths.
UNASSIGNED: Adjuvant chemotherapy should be appropriately discussed with patients. However, it may be reserved for relapse according to our data.