中华妇产科杂志
中華婦產科雜誌
중화부산과잡지
CHINESE JOUNAL OF OBSTETRICS AND GYNECOLOGY
2012年
12期
898-904
,共7页
卵巢肿瘤%生殖细胞瘤%妇科外科手术%保留生育功能%预后
卵巢腫瘤%生殖細胞瘤%婦科外科手術%保留生育功能%預後
란소종류%생식세포류%부과외과수술%보류생육공능%예후
Ovarian neoplasms%Germinoma%Gynecologic surgical procedures%Fertility preservation%Prognosis
目的 分析影响卵巢恶性生殖细胞肿瘤(MOGCT)保留生育功能手术患者预后及生育能力的临床病理因素.方法 回顾性分析1986年1月至2010年12月,广西医科大学附属肿瘤医院收治的106例MOGCT患者的临床资料和随访情况,以Kaplan-Meier法绘制生存曲线,采用log-rank检验比较单因素水平预后的差异,并用Cox回归模型进行多因素分析影响预后的因素,用logistic回归分析不同因素对生育能力的影响.结果 初次手术治疗中位年龄22岁(9 ～61岁),106例患者中行保留生育功能手术患者59例,未行保留生育功能手术者45例,术后94例患者进行了辅助化疗；有2例仅行活检术.中位随访时间56.5(2 ～309)个月,在无瘤存活的47例保留生育功能手术患者中45例有正常月经来潮,39例有生育愿望的患者中有31例患者成功妊娠,足月产33个健康婴儿.保留生育功能手术与未行保留生育功能手术患者的累积5年无进展生存率(分别为67.6％、63.3％)及总生存率(分别为70.0％、64.1％)分别比较,差异均无统计学意义(P＞0.05),病死率[分别为15％(9/59)、31％ (14/45)]比较,差异也无统计学意义(P =0.054).单因素分析显示,病理类型、术后残留病灶大小、淋巴结切除与否、大网膜切除与否与总生存期有关(P均＜0.1)；术后残留病灶大小、化疗疗程、淋巴结切除与否、大网膜切除与否与无进展生存期有关(P均＜0.1).多因素分析显示,仅有术后残留病灶大小影响患者总生存期(P =0.039)；术后残留病灶大小、化疗疗程、淋巴结切除与否是影响无进展生存期的独立因素(P均＜0.05).手术全面分期与否对保留生育功能手术患者术后生存率及生育能力均无影响(P＞0.05).结论 MOGCT患者手术联合化疗后有很好的预后,术后残留病灶大小可影响患者的预后,全面分期手术对预后无明显改善.保留生育功能手术对MOGCT患者预后及生育功能无明显影响.
目的 分析影響卵巢噁性生殖細胞腫瘤(MOGCT)保留生育功能手術患者預後及生育能力的臨床病理因素.方法 迴顧性分析1986年1月至2010年12月,廣西醫科大學附屬腫瘤醫院收治的106例MOGCT患者的臨床資料和隨訪情況,以Kaplan-Meier法繪製生存麯線,採用log-rank檢驗比較單因素水平預後的差異,併用Cox迴歸模型進行多因素分析影響預後的因素,用logistic迴歸分析不同因素對生育能力的影響.結果 初次手術治療中位年齡22歲(9 ～61歲),106例患者中行保留生育功能手術患者59例,未行保留生育功能手術者45例,術後94例患者進行瞭輔助化療；有2例僅行活檢術.中位隨訪時間56.5(2 ～309)箇月,在無瘤存活的47例保留生育功能手術患者中45例有正常月經來潮,39例有生育願望的患者中有31例患者成功妊娠,足月產33箇健康嬰兒.保留生育功能手術與未行保留生育功能手術患者的纍積5年無進展生存率(分彆為67.6％、63.3％)及總生存率(分彆為70.0％、64.1％)分彆比較,差異均無統計學意義(P＞0.05),病死率[分彆為15％(9/59)、31％ (14/45)]比較,差異也無統計學意義(P =0.054).單因素分析顯示,病理類型、術後殘留病竈大小、淋巴結切除與否、大網膜切除與否與總生存期有關(P均＜0.1)；術後殘留病竈大小、化療療程、淋巴結切除與否、大網膜切除與否與無進展生存期有關(P均＜0.1).多因素分析顯示,僅有術後殘留病竈大小影響患者總生存期(P =0.039)；術後殘留病竈大小、化療療程、淋巴結切除與否是影響無進展生存期的獨立因素(P均＜0.05).手術全麵分期與否對保留生育功能手術患者術後生存率及生育能力均無影響(P＞0.05).結論 MOGCT患者手術聯閤化療後有很好的預後,術後殘留病竈大小可影響患者的預後,全麵分期手術對預後無明顯改善.保留生育功能手術對MOGCT患者預後及生育功能無明顯影響.
목적 분석영향란소악성생식세포종류(MOGCT)보류생육공능수술환자예후급생육능력적림상병리인소.방법 회고성분석1986년1월지2010년12월,엄서의과대학부속종류의원수치적106례MOGCT환자적림상자료화수방정황,이Kaplan-Meier법회제생존곡선,채용log-rank검험비교단인소수평예후적차이,병용Cox회귀모형진행다인소분석영향예후적인소,용logistic회귀분석불동인소대생육능력적영향.결과 초차수술치료중위년령22세(9 ～61세),106례환자중행보류생육공능수술환자59례,미행보류생육공능수술자45례,술후94례환자진행료보조화료；유2례부행활검술.중위수방시간56.5(2 ～309)개월,재무류존활적47례보류생육공능수술환자중45례유정상월경래조,39례유생육원망적환자중유31례환자성공임신,족월산33개건강영인.보류생육공능수술여미행보류생육공능수술환자적루적5년무진전생존솔(분별위67.6％、63.3％)급총생존솔(분별위70.0％、64.1％)분별비교,차이균무통계학의의(P＞0.05),병사솔[분별위15％(9/59)、31％ (14/45)]비교,차이야무통계학의의(P =0.054).단인소분석현시,병리류형、술후잔류병조대소、림파결절제여부、대망막절제여부여총생존기유관(P균＜0.1)；술후잔류병조대소、화료료정、림파결절제여부、대망막절제여부여무진전생존기유관(P균＜0.1).다인소분석현시,부유술후잔류병조대소영향환자총생존기(P =0.039)；술후잔류병조대소、화료료정、림파결절제여부시영향무진전생존기적독립인소(P균＜0.05).수술전면분기여부대보류생육공능수술환자술후생존솔급생육능력균무영향(P＞0.05).결론 MOGCT환자수술연합화료후유흔호적예후,술후잔류병조대소가영향환자적예후,전면분기수술대예후무명현개선.보류생육공능수술대MOGCT환자예후급생육공능무명현영향.
Objective To analyse the clinicopathologic factors affecting prognosis and fertility of patients with malignant ovarian germ cell tumor (MOGCT).Methods The medical records and follow up data of 106 patients with MOGCT treated at Affiliated Tumor Hospital of Guangxi Medical University between January 1986 and December 2010.Kaplan-Meier method was used to analyse survival curves.The different prognoses between different clinicopathologic factor was 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 and fertility.Results The median age at primary treatment was 22 years old (range:9-61 years old),59 patients received fertility-preserving surgery,45 patients received radical surgery,only 2 cases performed biopsy; 94 patients received postoperative adjuvant chemotherapy.Median follow-up time was 56.5 months (range:2-309 months),there were 11 cases recurrences,23 cases died from cancer.Of 47 patients live without tumor,45 patients had normal menstrual.Of the 39 patients desiring pregnancy,31 cases got 33 successful pregnancies,resulting in 33 live births.There is no statistically significant difference (P ＞0.05) in progression free survival (PFS ; 67.6％ versus 63.3 ％) and overall survival (OS ; 70.0％ versus 64.1％) and mortality [15％ (9/59) versus 31％ (14/45)] between fertility-preserving surgery patients and radical surgery patients.The univariate analysis showed that the pathological types,postoperative residual tumor size,lymph nodes and omental resection were associated with OS (P ＜ 0.1),and postoperative residual tumor size,chemotherapy cycles,lymph nodes and omental resection were associated with PFS (P ＜0.1).The multivariate analysis showed only the postoperative residual tumor size was independent prognostic factor of OS (P =0.039),and postoperative residual tumor size,chemotherapy cycles,lymph nodes resection were independent prognostic factors of PFS (P ＜ 0.05).There is no statistically significant difference in OS,PFS and fertility between fertility-preserving surgery patients treated with or without a comprehensive staging surgery (P ＞ 0.05).Conclusions MOGCT can achieve a good prognosis after surgery combined chemotherapy.Postoperative residual tumor size is independent prognostic factor of PFS and OS.Comprehensive staging surgery could not improve prognosis.Fertility-preserving surgery plus adjuvant chemotherapy appeared to have little or no effect on prognosis and fertility.
