卵巢恶性生殖细胞肿瘤临床病理特征及预后因素分析

蒋红元; 刘艳; 王肖; 赵婷; 卢媛

卵巢恶性生殖细胞肿瘤临床病理特征及预后因素分析

Clinical-pathological features and prognostic factors of ovarian malignant germ cell tumor

摘要

摘要: 目的： 探讨卵巢恶性生殖细胞肿瘤的临床病理特征及预后影响因素。方法： 选取1997年10月至2014年12月在复旦大学附属妇产科医院就诊并经病理证实为卵巢恶性生殖细胞肿瘤患者共132例，收集患者病史资料并随访预后，采用SPSS 20.0软件进行生存分析，Kaplan-Meier法绘制生存曲线，log-rank检验单因素分析预后影响因素，Cox回归模型多因素分析预后影响因素。结果： 132 例患者年龄10~63岁，平均(25±9.43)岁。其中未成熟畸胎瘤56例(42.4%)，卵黄囊瘤28例(21.2%)，无性细胞瘤28例(21.2%)，混合性细胞瘤18例(13.6%)，其他2例(1.5%)。FIGO分期：Ⅰ期115例(87.1%)，Ⅱ期6例(4.5%)，Ⅲ期 9例(6.8%)，Ⅳ期2例(1.5%)。共随访4~207个月，其中失访5例，失访率3.8%；复发13例，死亡5例；5年无病生存率86.7%，5年总生存率95.2%。单因素分析显示，保留与非保留生育功能手术对患者5年无病生存率影响差异无统计学意义(91.5% vs 78.2%)，对5年总生存率的影响差异有统计学意义(98.5% vs 85.4%，P=0.041)；肿瘤FIGO分期对患者预后的影响差异有统计学意义(P< 0.05)。Cox回归模型多因素分析显示FIGO分期是影响患者5年无病生存率和5年总生存率的独立预后因素(P=0.031，P=0.029)。结论： 卵巢恶性生殖细胞肿瘤患者发病年轻，预后良好，FIGO分期是影响预后的独立危险因素。对于年轻未生育患者，可行保留生育功能手术，对于明显早期患者可不进行完整分期手术，不行盆腔淋巴结清扫及大网膜切除术。

Abstract: Objective： To investigate the clinical-pathologicalfeatures and prognostic factors of malignant ovarian germ cell tumor(MOGCT). Methods： The clinical data of 132 MOGCTs treated in the Obstetrics and Gynecology Hospital of Fudan University between during October 1997 to December2014 was retrospectively reviewed, Kaplan-Meier method was used to analyse survival curves; The different prognoses between different clinical features were evaluated by univariate analysis and log-rank test; the multivariate analysis was performed by the Cox proportional hazard regression method. Logistic regression analysis was used to evaluate the influence of different factors on the prognoses by Spss20.0 software. Results： There were 56 cases (42.4%) of teratoma, 28 cases (21.2%) of yolk sac tumor, 28 cases (21.2%) of dysgerminoma, 18 cases (13.6%) of mixed germ cell tumors, 2 patients (1.5%) of others. FIGO stage: Ⅰ stage 115 cases (87.1%); Ⅱ stage 6 cases (4.5%), Ⅲ stage 9 case (6.8%), Ⅳ stage 2 cases (1.5%). During the follow-up of 3 to 207 months, of which 5 cases were lost, the rate of lost was 3.8%, 12 patients recurrence, 5 died, 5-year disease-free survival rate was 88.7%, the 5-year overall survival rate was 96.9%. Univariate analysis showed that: the age of patients, comprehensive staging surgery, lymph nodes dissection and omentectomy、Pathological type and tumor location have no influence on five year disease-free survival and overall survival rate, and fertility-sparing surgery has no influence on five year disease-free survival rate (91.5%，78.2%), but were associated with five years overall survival rate (98.5%，85.4%；P=0.041). FIGO stage has influence on prognosis (P< 0.05). Multivariate analysis showed that only FIGO stage was the independent factor affecting the five year disease-free survival rate and overall survival rate (P=0.031，P=0.029). Conclusions： MOGCTs always affect children and teenagers and has a good prognosis. FIGO stage is the independent prognostic factor. For young nulliparous patients, we can take conservative surgery without systematically pelvic lymph node dissection and omentectomy, in order to preserve fertility and reduce surgical trauma as far as possible.

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