保留生育功能手术及淋巴结切除对卵巢恶性生殖细胞肿瘤患者预后的影响:基于SEER数据库的研究  

Prognostic factors for patients with malignant ovarian germ cell tumors following fertility-sparing surgery with lymphade nectomy:an analysis based on SEER database

作　　者：过华蕾 陈豪 王文慧 尹晓娜 龚仪棠 GUO Hualei;CHEN Hao;WANG Wenhui;YIN Xiaona;GONG Yitang(Department of Pathology,Hangzhou Obstetrics and Gynecology Hospital,Hangzhou 310008,China)

机构地区：[1]杭州市妇产科医院病理科,310008

出　　处：《浙江医学》2022年第20期2154-2159,I0003,I0004,共8页Zhejiang Medical Journal

摘　　要：目的探讨保留生育功能手术及淋巴结切除对不同国际妇产科协会(FIGO)分期卵巢恶性生殖细胞肿瘤(MOGCT)患者预后的影响。方法从美国国立癌症研究所监测、流行病学和结果(SEER)数据库中获取2004—2014年卵巢肿瘤患者的临床病理资料,筛选原发部位为卵巢,组织学分型为MOGCT的患者共计1475例,其中无性细胞瘤419例、胚胎性癌6例、卵黄囊瘤215例、恶性畸胎瘤631例和混合性恶性生殖细胞肿瘤204例。采用多因素Cox回归分析影响MOGCT患者总生存期(OS)的因素。对不同FIGO分期的MOGCT患者进行分层生存分析,比较不同手术方式和淋巴结切除数目MOGCT患者的OS。结果多因素Cox回归分析显示,年龄30~50岁和>50岁(相对于<30岁),组织学类型为胚胎性癌、卵黄囊瘤和恶性畸胎瘤(相对于无性细胞瘤),组织学分级为Ⅲ级、Ⅳ级(相对于Ⅰ级),肿瘤直径>10 cm(相对于<5 cm),FIGO分期为Ⅲ期、Ⅳ期(相对于Ⅰ期)均是影响MOGCT患者OS的危险因素,而手术方式为保留生育功能手术和不保留生育功能手术(相对于未手术)、进行化疗(相对于否/未知)、糖类抗原125阴性/正常(相对于阳性/升高)均是影响MOGCT患者OS的保护因素(均P<0.05)。分层生存分析显示,FIGOⅢ、Ⅳ期患者中,未手术组、保留生育功能手术组和不保留生育功能手术组OS比较差异均有统计学意义(均P<0.01)。FIGOⅢ期患者中,淋巴结未切除组、切除1~3个组和切除≥4个组OS比较差异有统计学意义(P<0.05)。结论对于FIGOⅠ、Ⅱ和Ⅳ期MOGCT患者,没有必要进行不保留生育功能手术和淋巴结清扫,仅FIGOⅢ期患者才能从不保留生育功能手术和更多数目的淋巴结切除中获益。Objective To investigate the prognostic factors for patients with malignant ovarian germ cell tumors(MOGCT)following fertility-sparing surgery(FSS)with lymphadenectomy.Methods The clinicopathological data of 1475 MOGCT patients from 2004 to 2014 were obtained from the surveillance,epidemiology and end results(SEER)database of the National Cancer Institute.There were 419 cases of asexual cell tumor,6 cases of embryonal carcinoma,215 cases of yolk sac tumor,631 cases of malignant teratoma and 204 cases of mixed malignant germ cell tumor.Clinicopathological features were analyzed in MOGCT of different histological types.Multivariate Cox regression analysis was used to analyze the factors affecting overall survival(OS)of MOGCT patients.Results Multivariate Cox regression analysis showed that 30-50 years and>50 years of age(compared with<30 years),embryonal carcinoma,yolk sac tumor,malignant teratoma(compared with asexual cell tumor),the histological gradeⅢ,Ⅳ(compared with gradeⅠ),and the tumor diameter>10 cm(compared with<5 cm),FIGO stageⅢ,Ⅳ(compared with stageⅠ)were risk factors for OS in patients with MOGCT.FSS and non-FSS(compared with no operation),chemotherapy(compared with no/unknown),and CA125 negative/normal(compared with positive/elevated)were protective factors for OS in patients with MOGCT(all P<0.05).Stratified survival analysis showed that in patients with FIGO stageⅢandⅣ,there were significant differences in OS among non-surgical,patients with FSS and patients with non-FSS(both P<0.01);in patients with FIGO stageⅢ,there were significant differences in OS among patients with unresected lymph nodes,with 1~3 lymph nodes resected and with≥4 lymph nodes resected(P<0.05).Conclusion The study indicates that for FIGO stageⅠ,ⅡandⅣMOGCT patients,it may be not necessary to perform non-FSS and lymph node dissection;and only FIGOⅢpatients may benefit from FSS and more lymph node removal.

关 键 词：卵巢恶性生殖细胞肿瘤 保留生育功能手术 淋巴结切除 SEER数据库 

分 类 号：R737.31[医药卫生—肿瘤]