基于SEER数据库分析卵巢卵黄囊瘤的临床病理特征及预后影响因素  

The clinicopathological features and prognostic factors of ovarian yolk sac tumor:a SEER population-based study

作　　者：陈雪莲 何连利 Chen Xuelian;He Lianli(Department of Gynecology,the Third Affiliated Hospital of Zunyi Medical University/The First People's Hospital of Zunyi,Zunyi 563000)

机构地区：[1]遵义医科大学第三附属医院遵义市第一人民医院妇科,贵州563000

出　　处：《现代妇产科进展》2022年第10期751-757,共7页Progress in Obstetrics and Gynecology

基　　金：贵州省卫生健康委科学技术基金项目(No:gzwkj2021-311)。

摘　　要：目的:探讨卵巢卵黄囊瘤(OYST)的临床病理特征及其预后影响因素。方法:收集SEER数据库中于2000至2018年诊断为OYST的376例患者的数据资料,采用Joinpoint软件分析OYST的发病率变化情况;采用Kaplan-Meier法绘制生存曲线并用log-rank法进行检验;采用单因素及多因素Cox比例风险回归模型分析患者生存的影响因素。结果:共376例患者纳入分析,中位年龄23岁(1~82岁),中位生存时间80月(0~227月),5年生存率(OS)为87.2%。Joinpoint分析结果显示,2000至2018年间OYST发病率呈逐年上升趋势,平均年度变化百分比(AAPC)为1.55%(95%CI为0.7%~2.3%,P=0.2)。手术和化疗是OYST患者主要的治疗方式,手术联合化疗治疗患者的5年OS明显优于单纯手术(P=0.016)及单纯化疗(P<0.001);保留生育功能手术患者的5年OS明显优于不保留者(96.3%vs 80.7%,P<0.001)。对于肿瘤分期处于早期(Ⅰ期)的患者,手术联合化疗与单纯手术治疗之间比较差异无统计学意义(93.1%vs 89.8%,P=0.961),是否行保留生育功能手术及子宫切除术之间比较差异均无统计学意义(P>0.05)。多因素分析结果显示,年龄、TNM分期、手术方式、淋巴结切除数及化疗是OYST患者预后的独立影响因素。结论:手术联合化疗为OYST最佳的治疗方式,化疗不能为年轻患者和早期肿瘤带来获益,适度范围的淋巴结清扫与更好的预后相关。年龄、TNM分期、手术方式、淋巴结切除数及化疗是OYST患者生存预后的独立影响因素。Objective:To investigate the clinicopathological characteristics and prognostic factors of patients with ovarian yolk sac tumor(OYST).Methods:376 patients diagnosed with OYST between 2000 and 2018 were extracted from the Surveillance,Epidemiology,and End Results(SEER)database.Changes in incidence trends were assessed using the average annual percentage change(AAPC),calculated with Joinpoint software.Kaplan-Meier method with the Log-rank test was applied to compare survival curves.Univariate and multivariate survival analyses were performed using the Cox proportional hazards model.Results:A total of 376 patients with a median age of 28 years(range:1~82 years)were included.The median overall survival time was 80 months(range:0~227 months).The 5-year overall survival rates were 87.2%.In recent years,the incidence of OYST presents an increasing trend year by year with an AAPC of 1.55%(95%CI:0.7%~2.3%,P=0.2).Surgery and chemotherapy constitute the main treatment modalities for OYST.The group treated by both surgery and chemotherapy had better prognosis than the group that had received surgery only(P=0.016)or chemotherapy alone(P<0.001).Patients underwent fertility-sparing surgery showed better 5-year OS than patients did not(96.3%vs 80.7%,P<0.001).For patients with stage I disease,statistical significances were not found between surgery plus chemotherapy and surgery alone(93.1%vs 89.8%,P=0.961),and there were no significant differences in fertility-sparing surgery or hysterectomy between the two group(P>0.05).Multivariate analysis showed that age,TNM stage,surgery,the number of lymph nodes and chemotherapy were the independent prognostic factors for OYST.Conclusions:The best treatment option for patients with OYST is combined treatment with surgery and chemotherapy.Young patients and patients with early-stage tumors did not achieve long-term benefit from adjuvant chemotherapy.The appropriate extent of lymph node dissection was correlated with a better prognosis.Age,TNM stage,surgery,the number of lymph nodes and chemo

关 键 词：卵巢 卵黄囊瘤 预后 保留生育功能手术 化疗 

分 类 号：R737.33[医药卫生—肿瘤]