Ⅱ~Ⅲ期卵巢交界性肿瘤患者保留生育功能手术的肿瘤及生育结局分析  

Oncological and reproductive outcomes after fertility-sparing surgery in patients with stageⅡ-Ⅲborderline ovarian tumor

作　　者：郑果 刘亚娜 王倩[1] 付翰林 司露露 来天娇 郭瑞霞[1] Zheng Guo;Liu Ya′na;Wang Qian;Fu Hanlin;Si Lulu;Lai Tianjiao;Guo Ruixia(Department of Gynecology,the First Affiliated Hospital of Zhengzhou University,Zhengzhou 450052,China)

机构地区：[1]郑州大学第一附属医院妇科,郑州450052

出　　处：《中华妇产科杂志》2024年第9期702-709,共8页Chinese Journal of Obstetrics and Gynecology

基　　金：河南省中青年卫生健康科技创新领军人才培养项目(YXKC2020012)。

摘　　要：目的探讨接受保留生育功能手术(FSS)的Ⅱ~Ⅲ期卵巢交界性肿瘤(BOT)患者的肿瘤及生育结局。方法回顾性收集2011年1月至2023年3月在郑州大学第一附属医院接受FSS的40岁及以下Ⅱ~Ⅲ期BOT患者的临床病理资料及随访资料,分析其肿瘤结局,采用单因素及多因素Cox比例风险回归模型分析影响患者无病生存(DFS)时间的相关因素;并分析其生育结局。结果(1)一般临床病理资料:本研究纳入接受FSS治疗的Ⅱ~Ⅲ期BOT患者共79例,其年龄为(27.5±6.7)岁,中位肿瘤最大径为10.4 cm(范围:4.8~90.0 cm),国际妇产科联盟(FIGO)分期为Ⅱ期45例、Ⅲ期34例,病理类型为浆液性48例、黏液性21例、子宫内膜样1例、混合型9例,肿瘤累及单侧卵巢41例、累及双侧卵巢38例,伴微浸润5例,微乳头亚型17例,卵巢外浸润性种植5例,合并腹水31例。(2)肿瘤结局:中位随访时间为58个月(范围:8~146个月),随访期内24例(30%,24/79)患者复发,其中二次复发5例、三次复发2例;2例(3%,2/79)死亡,1例(1%,1/79)带瘤生存。(3)影响DFS时间的相关因素分析结果:单因素分析显示,病理类型为交界性黏液性肿瘤、肿瘤最大径>13.15 cm、FIGO分期为Ⅲ期、合并腹水、微乳头亚型、卵巢外浸润性种植、累及双侧卵巢均显著影响接受FSS治疗的Ⅱ~Ⅲ期BOT患者的DFS时间(P均<0.05)。多因素分析显示,FIGO分期为Ⅲ期(HR=4.555,95%CI为1.525~13.607)、微乳头亚型(HR=2.396,95%CI为1.003~5.725)是影响接受FSS治疗的Ⅱ~Ⅲ期BOT患者DFS时间的独立危险因素(P均<0.05)。(4)生育结局:随访期内有生育意愿者36例(46%,36/79),其中29例(81%,29/36)成功妊娠,27例(75%,27/36)成功生育健康儿。结论Ⅱ~Ⅲ期BOT患者行FSS后有良好的生存率和生育率。FIGO分期为Ⅲ期及微乳头亚型是影响患者DFS时间的独立危险因素。ObjectiveTo evaluate oncological and reproductive outcomes of women≤40 years undergoing fertility-sparing surgery(FSS)for stageⅡorⅢborderline ovarian tumor(BOT).MethodsThe patients with BOT and≤40 years old with stageⅡ-ⅢBOT who underwent FSS enrolled from the First Affiliated Hospital of Zhengzhou University between January 2011 and March 2023 were analyzed retrospectively.The clinical data and follow-up results were obtained and analyzed.The univariate and multivariate Cox proportional hazard regression analysis were used to explore high-risk factors associated with prognosis.Additionally,pregnancy outcomes were also analyzed.Results(1)A total of 79 patients with stageⅡ-ⅢBOT who have been treated with FSS were conducted,with an average age of(27.5±6.7)years old.The median tumor maximum diameter were 10.4 cm(range:4.8-90.0 cm).The International Federation of Gynecology and Obstetrics(FIGO)stage was stageⅡin 45 cases and stageⅢin 34 cases.According to the pathological types,there were 48 cases of serous tumor,21 cases of mucinous tumor,1 case of endometrioid tumor,and 9 cases of mixed types.There were 41 cases of unilateral ovarian involvement,38 cases of bilateral ovarian involvement.There were 5 cases of microinvasion,17 cases of micropapillary subtype.Extra-ovarian invasive implants were found in 5 cases,and there were 31 cases of merged ascites.(2)Tumor outcomes:the median follow-up time from primary cytoreduction were 58 months(range:8-146 months).At the end of the observation period,24 cases(30%,24/79)recurred,among them 5 cases had two recurrences and 2 cases had three recurrences.There were 2 cases(3%,2/79)of death and 1 case(1%,1/79)of survival with tumor.(3)Analysis of prognostic risk factors:the results of univariate analysis showed that mucinous tumor,tumor maximum diameter>13.15 cm,FIGO stageⅢ,merged ascites,micropapillary subtype,invasive implantation,and bilateral ovarian involvement were independent risk factors(all P<0.05)for disease-free survival(DFS).FIGO stageⅢ(HR=4.555

关 键 词：卵巢肿瘤 保留生育能力 存活率 生育力 治疗结果 回顾性研究 

分 类 号：R737.33[医药卫生—肿瘤]