保留生育功能手术对卵巢交界性肿瘤患者预后及生育结局的影响  

Prognosis and fertility outcomes of patients with borderline ovarian tumors after fertility-sparing surgery

作　　者：张悦[1] 王倩男 黄珍 褚然 董涛涛[1] 张友忠[1] 杨兴升[1] 姜洁[1] 崔保霞[1] 宋坤[1] 孔北华[1,2] Zhang Yue;Wang Qiannan;Huang Zhen;Chu Ran;Dong Taotao;Zhang Youzhong;Yang Xingsheng;Jiang Jie;Cui Baoxia;Song Kun;Kong Beihua(Department of Obstetrics and Gynecology,Qilu Hospital,Shandong University,Jinan 250012,China;Department of Gynecology,Ganzhou Maternal and Child Health Hospital,Ganzhou 341000,China)

机构地区：[1]山东大学齐鲁医院妇产科,济南250012 [2]江西省赣州市妇幼保健院妇科,赣州341000

出　　处：《中华医学杂志》2022年第26期1999-2004,共6页National Medical Journal of China

基　　金：国家重点研发项目(2019YFC1005200,2019YFC1005204);泰山学者青年专家专项基金(tsqn201812130);驻济高校妇科肿瘤靶向策略研发工作室资助项目(2019GXRC049)。

摘　　要：目的探讨保留生育功能手术对卵巢交界性肿瘤(BOT)患者预后及生育结局的影响。方法纳入山东大学齐鲁医院2009—2019年确诊治疗的280例卵巢交界性肿瘤患者为研究对象,根据患者的手术方案,将患者分为保留生育功能手术组(保留组,167例)和未保留生育功能手术组(未保留组,113例),收集患者年龄、术前血清CA-125水平、手术方式、病理类型、国际妇产科联盟(FIGO)分期(2014)、肿瘤部位、是否合并局灶癌变等信息,并对患者术后的预后比较两组患者的术后无病生存率差异,采用多因素Cox比例风险回归模型分析卵巢交界性肿瘤患者预后的相关因素。结果 280例BOT患者的年龄[M(Q1,Q3)]为35.0(26.0,51.0)岁,术后随访时间[M(Q1,Q3)]为55.2(34.7,79.3)个月。随访期间,保留组共有25例(15.0%)患者复发,未保留组共有11例(8.7%)复发。保育组和非保育组患者5年无病生存率分别为84.4%和90.1%(P=0.223)。多因素Cox比例风险回归分析显示,与FIGO Ⅰ期患者相比,FIGO Ⅱ/Ⅲ期患者复发的风险更高,HR值(95%CI)为2.872(1.283~6.431)(P=0.010),行保留生育功能手术未增加患者复发风险(P=0.116)。共随访到72例患者有妊娠意愿,39例(54.2%)患者成功妊娠,其中37例成功分娩,2例选择性终止妊娠。结论保育手术并未增加BOT患者肿瘤复发的风险且生育结局良好;FIGO分期是BOT患者预后的相关因素。Objective To explore the clinical prognosis and fertility outcomes in patients with borderline ovarian tumors(BOT)who underwent fertility-sparing surgery,and evaluate the related risk factors.Methods The study examined the clinicopathological characteristics of 280 patients diagnosed with BOT from Qilu Hospital of Shandong University between January 2009 and December 2019.According to the surgery plan,the patients were divided into the fertility-sparing group(167 cases)and the radical surgery group(113 cases).The information of the patients′age,preoperative serum CA-125 level,surgery method,pathological type,FIGO stage(2014),tumor location,and whether focal canceration combined were collected.The Kaplan-Meier method was used to compare disease-free survival(DFS)between the fertility-sparing surgery group and the radical surgery group.The univariate and multivariate Cox proportional hazard regression analysis was used to explore high-risk factors associated with DFS.Results A total of 280 BOT patients were identified in the study,with a median age of 35.0(26.0,51.0)years old.The median follow-up time was 55.2(34.7,79.3)months.25 patients(15.0%)developed recurrence in the fertility-sparing surgery group,11 patients(8.7%)developed recurrence in the radical surgery group.There was no significant difference in 5-year DFS rate between the two groups(84.4%vs 90.1%,P=0.223).Only FIGO stage was found to be related to DFS through the univariable and multivariable Cox proportional hazard regression analysis,and patients with FIGOⅡ/Ⅲhad higher risk of recurrence[HR(95%CI)2.872(1.283-6.431)](P=0.010);Fertility-sparing surgery does not increase the recurrence risk of BOT patients(P=0.116).Pregnancies were reported in 39 patients(54.2%),among whom 37 patients gave birth successfully,and 2 patients selected to terminate pregnancy.Conclusions The fertility-sparing surgery does not increase the risk of recurrence in BOT patients,and patients who underwent the fertility-sparing surgery have a favorable outcome.FIGO stage is t

关 键 词：卵巢疾病 卵巢交界性肿瘤 保留生育功能治疗 无病生存率 妊娠率 

分 类 号：R737.31[医药卫生—肿瘤]