卵巢幼年型颗粒细胞瘤的临床病理特征及预后分析  

Clinical characteristics and prognosis of ovarian juvenile granulosa cell tumors

作　　者：马潇 张功逸 李哲 Ma Xiao;Zhang Gongyi;Li Zhe(Department of Obstetrics and Gynecology,Beijing Pinggu District Hospital,Beijing101299,China;Department of Gynecology,National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital,Peking Union Medical College,Chinese Academy of Medical Sciences,Beijing100021,China)

机构地区：[1]北京市平谷区医院妇产科,北京101299 [2]国家癌症中心,国家肿瘤临床医学研究中心,中国医学科学院北京协和医学院肿瘤医院妇科,北京100021

出　　处：《中华妇产科杂志》2025年第1期34-45,共12页Chinese Journal of Obstetrics and Gynecology

摘　　要：目的探讨卵巢幼年型颗粒细胞瘤(JGCT)患者的临床病理特征、治疗及预后。方法从美国国立癌症研究所的监测、流行病学及最终结果(SEER)数据库中收集2000—2021年期间诊断为卵巢JGCT的34例患者的临床病理资料及随访资料进行回顾性分析,总结卵巢JGCT患者的临床病理特征、治疗及预后。采用倾向性评分匹配(PSM)方法匹配SEER数据库中的卵巢成人型颗粒细胞瘤(AGCT)64例,共有96例卵巢颗粒细胞瘤(OGCT)患者(包括32例JGCT和64例AGCT)纳入匹配后的队列分析,对匹配后队列采用单因素及多因素Cox回归模型分析其预后影响因素;并采用Kaplan-Meier法绘制生存曲线,log-rank检验比较JGCT与AGCT患者的预后差异。结果(1)34例卵巢JGCT患者的中位诊断年龄为19.5岁(范围:1~48岁),其中≤10岁3例,11~20岁16例,21~30岁11例,>30岁4例;肿瘤位置:33例患者的肿瘤位于单侧卵巢,仅1例Ⅳ期患者的肿瘤位于双侧卵巢;肿瘤最大径:26例患者有记录,中位肿瘤最大径为12.4 cm(范围:3.5~40.0 cm);国际妇产科联盟(FIGO)2014年分期:Ⅰ期19例(其中Ⅰa期10例、Ⅰc期9例),Ⅱ期4例,Ⅲ期8例,Ⅳ期3例。手术方式:有2例患者(Ⅰc、Ⅳ期各1例)未对病灶行手术治疗,多数Ⅰ期患者(15/19)行保留生育功能手术,Ⅱ~Ⅲ期患者行保留生育功能手术或肿瘤细胞减灭术(各6例),Ⅳ期患者(2例)行肿瘤细胞减灭术;淋巴结转移:术中切除淋巴结的患者共有10例,其中仅1例患者淋巴结阳性;放化疗:34例患者术后均未接受放疗,18例患者接受化疗(包括术前和术后化疗),其中Ⅰ期患者接受的化疗比例较低,仅为4/19(其中Ⅰa期2/10、Ⅰc期2/9),Ⅱ、Ⅲ、Ⅳ期患者分别为3/4、8/8、3/3。随访截止时间为2021年12月,随访期内20例患者存活、14例死亡,卵巢JGCT患者的总生存(OS)率为59%(20/34);其中,Ⅰ期患者为16/19,Ⅱ~Ⅳ期患者为4/15,两者比较,差异有统计学意义(P=0.002);Ⅱ~Ⅲ期患者中,保留生�ObjectiveTo analyze the clinical characteristics,treatments,and prognosis of patients with ovarian juvenile granulosa cell tumor(JGCT).MethodsClinical and pathological data,and follow-up information of 34 patients diagnosed with JGCT from 2000 to 2021 were collected from the surveillance,epidemiology,and end results(SEER)database.A retrospective analysis was conducted to summarize the patients′clinical and pathological characteristics,treatments,and prognosis.Propensity score matching(PSM)was used to match the JGCT cases with adult granulosa cell tumor(AGCT)cases in SEER database.A total of 96 patients with ovarian granulosa cell tumor(OGCT),including 32 cases of JGCT and 64 cases of AGCT,were enrolled in a matched cohort analysis.Univariate and multivariate Cox regression analysis were performed on the matched cohort to explore the risk factors for overall survival.Kaplan-Meier curves and the log-rank test were used to compare the survival outcomes between JGCT and AGCT.Results(1)The median age at diagnosis for the 34 JGCT patients was 19.5 years(ranged:1-48 years),with 3 patients aged≤10 years,16 patients aged 11-20 years,11 patients aged 21-30 years,and 4 patients aged>30 years.Tumors originated unilaterally in 33 patients,with only 1 case originating bilaterally.The maximum tumor diameter was recorded in 26 patients,with a median size of 12.4 cm(ranged:3.5-40.0 cm).According to the 2014 International Federation of Gynecology and Obstetrics(FIGO)staging system,19 patients were diagnosed with stageⅠ(including 10 cases with stageⅠa and 9 cases with stageⅠc),4 patients with stageⅡ,8 patients with stageⅢ,and 3 patients with stageⅣ.Two patients did not undergo surgery for the resection of lesions.StageⅠpatients(15/19)underwent fertility-sparing surgery,while stageⅡ-Ⅲpatients underwent either fertility-sparing surgery or cytoreductive surgery(6 cases each).StageⅣpatients underwent cytoreductive surgery(2 cases).Lymph node dissection was performed in 10 patients,among which only 1 patient with

关 键 词：卵巢肿瘤 颗粒细胞瘤 保留生育功能 预后 

分 类 号：R73[医药卫生—肿瘤]