血清肿瘤标志物阴性颅内未成熟畸胎瘤的治疗策略和预后  

Therapeutic strategies and outcomes of intracranial immature teratoma with negative serum tumor markers

作　　者：黄翔 张超[1,2] 汪洋 王恩敏[1,2] 张荣 Huang Xiang;Zhang Chao;Wang Yang;Wang Enmin;Zhang Rong(Department of Neurosurgery,Huashan Hospital,Fudan University,Shanghai 200040,China;Institute of Neurosurgery,Fudan University,Shanghai 201107,China)

机构地区：[1]复旦大学附属华山医院神经外科,上海200040 [2]复旦大学,神经外科研究所,上海201107

出　　处：《中华神经外科杂志》2020年第9期891-895,共5页Chinese Journal of Neurosurgery

摘　　要：目的探讨术前血清肿瘤标志物甲胎蛋白(AFP)和β人绒毛膜促性腺激素(β-hCG)阴性的颅内未成熟畸胎瘤的治疗措施和预后。方法回顾性分析1997年1月至2019年12月复旦大学附属华山医院神经外科收治的术前血清AFP和β-hCG呈阴性的23例颅内未成熟畸胎瘤患者的临床资料。所有患者均行手术切除肿瘤。术后行放疗18例(其中仅行常规放疗10例,常规放疗联合伽玛刀治疗7例,仅行伽玛刀治疗1例),行化疗10例。通过Kaplan-Meier法和Log-rank检验进行生存分析和比较。结果 23例患者中,肿瘤全切除16例,次全切除4例,部分切除3例。术后病理学结果提示,19例为未成熟畸胎瘤,4例为混合性生殖细胞肿瘤(含未成熟畸胎瘤成分)。23例患者中,2例失访,获随访21例;5年、10年生存率分别为71.7%和65.7%。Log-rank检验分析结果显示,术后常规放疗、化疗均非颅内未成熟畸胎瘤患者生存率的影响因素(均P>0.05)。术后肿瘤残留或复发的16例患者中,行伽玛刀治疗者(8例)和未予伽玛刀治疗者(8例)的5年生存率分别为100.0%和28.6%(P=0.01)。结论对于术前血清AFP和β-hCG呈阴性的颅内未成熟畸胎瘤,应首选手术治疗并尽可能达到全切除。术后如肿瘤残留或随访期间肿瘤复发,及时行伽玛刀治疗作为放化疗的补充方案,可使患者获得较长的生存期。Objective To investigate the therapeutic strategies and prognosis of intracranial immature teratomas with negative serum tumor markers including alpha fetoprotein(AFP)and beta human chorionic gonadotropin(0-hCG).Methods We retrospectively analyzed the clinical data of 23 intracranial immature teratoma patients with negative preoperative serum tumor markers(AFP and p-hCG)who were admitted to Department of Neurosurgery,Huashan Hospital,Fudan University from January 1997 to December 2019.All patients underwent surgery to remove the tumor.Among them,postoperative radiotherapy(merely conventional radiotherapy in 10,conventional radiotherapy combined with gamma knife therapy in 7,and merely gamma knife therapy in 1)was performed in 18 patients and chemotherapy in 10.Kaplan-Meier method and log-rank test were used for survival analysis and comparison.Results Of the 23 patients,16 underwent total resection,4 had subtotal resection,and 3 had partial resection.Postoperative pathological results indicated 19 cases of immature teratoma and 4 cases of mixed germ cell tumor containing immature teratoma components.Of the 23 patients,2 were lost to follow-up and 21 were followed up.The 5-year and 10-vear survival rates of 23 patients were 71.7%and 65.7%,respectively.Lag-rank analysis results showed that postoperative radiotherapy and chemotherapy were not influencing factors for the survival rate of patients(both P>0.05).Among the 16 patients with residual tumors or recunent tumors after surgery,the 5-year survival rates of those undergoing gamma knife treatment(8 cases)and those without gamma knife treatment(8 cases)were 100.0%and 28.6%respectively(P=0.01).Conclusions As for intracranial immature teratonia with negative preoperative serum tumor markers,surgical treatment should be preferred and total resection should be achieved as far as possible.Timely treatment using Gamma knife could be an effective complementary therapy for postoperative residual or recurrent tumor,which could lead to a relatively long survival.

关 键 词：畸胎瘤 神经外科手术 预后 伽玛刀治疗 肿瘤标记 生物学 

分 类 号：R739.41[医药卫生—肿瘤]