卵巢恶性生殖细胞肿瘤保留生育功能手术患者预后及生育能力的影响因素分析  

Prognostic factors analysis in patients with ovarian malignant germ cell tumor treated with fertilitypreserving surgery

作　　者：阳志军[1] 韦任姬[1] 李力[1] 

机构地区：[1]广西医科大学附属肿瘤医院妇瘤科,南宁530021

出　　处：《中华妇产科杂志》2012年第12期898-904,共7页Chinese Journal of Obstetrics and Gynecology

摘　　要：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�Objective To analyse the clinieopathologic 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 clinieopathologic 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 mouths）, 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% versus64. 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, ehemotherapy 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 faetor of OS （ P = 0. 039 ）

关 键 词：卵巢肿瘤 生殖细胞瘤 妇科外科手术 保留生育功能 预后 

分 类 号：R737.31[医药卫生—肿瘤]