卵巢颗粒细胞瘤预后影响因素的分析

目的 探讨卵巢颗粒细胞瘤临床、病理因素对预后的影响。方法 回顾性分析我院１９５８年至１９９５年收治的１００例卵巢颗粒细胞瘤患者的年龄、临床分期、核分裂相及早期患者的治疗方法选择等因素与预后的,并对复发与未复发患者,近期复发（〈１０年）与远期复发（≥１０年）患者进行比较。结果 全组总的５年和１０年生存率分别为８０％和７２％。不同年龄患者（≥４０岁,〈４０岁）的５年和１０年生存率,分别比较,差异无显著性（Ｐ〉０．０５）。临床分期为Ⅰ期者５年和１０年生存率分别为９８％和９６％,Ⅱ期分别为７０％和６０％,Ⅲ～Ⅳ期均为０％;外院治疗后复发或未控者５年和１０年生存率分别为５８％和４０％,分别比较,差异均有显著性（Ｐ均〈０．０５）。４７例有核分裂相计数的患者中,核分裂相〈５／１０高倍视野（ＨＰＦ）的５年和１０年生存率均为９６     

卵巢颗粒细胞瘤的治疗与预后(23例临床分析)

目的 对23例卵巢颗粒细胞瘤的治疗及可能的预后因素进行回顾性分析,探讨手术、化疗、放疗在卵巢颗粒细胞瘤治疗中的意义。方法 研究对象为北京协和医院1980年1月至1999年12月20年间收治的卵巢颗粒细胞瘤患者23例,患者的年龄范围为5～61岁,平均年龄38.4岁。随诊时间为1～14年,随访率为91.4％。统计学分析方法:采用SPSS(version 8.0)进行数据分析,生存率的计算采用Kaplan-Meier法。结果23例卵巢颗粒细胞瘤临床病理分期为Ⅰ期20例,占87.0％,Ⅱ期1例,占4.3％,Ⅲ期2例,占8.7％,临床Ⅰ-Ⅲ期5年生存率在90%以上。病理切片分析,成年型20例,幼年型3例,幼年型患者1年生存率<50%。卵巢颗粒细胞瘤的复发率为34.8％,复发与临床病理分期、手术方式及肿瘤大小有关。结论 卵巢颗粒细胞瘤是一种低度恶性的卵巢肿瘤,生存率高,局部复发,晚期复发。预后相关因素包括临床病理分期、病理类型、肿瘤大小以及初次手术方式。手术治疗仍是卵巢颗粒细胞瘤的主要治疗手段。临床Ⅰc期以上,病理类型不良,肿瘤直径大于l0cm,则最好辅以化疗。放疗主要用于盆腔局部复发、手术难以切除或切净的患者。     

早期成人型卵巢颗粒细胞瘤复发相关因素分析北大核心CSCD

目的探讨国际妇产科联盟(FIGO)(2014版)Ⅰ期成人型卵巢颗粒细胞瘤复发的相关高危因素。方法回顾性分析首都医科大学附属北京朝阳医院及中国医学科学院北京协和医院1995年1月至2010年1月收治的FIGOⅠ期成人型卵巢颗粒细胞瘤。分析患者临床及病理相关因素与肿瘤复发的关系。结果研究共纳入18例FIGOⅠ期成人型卵巢颗粒细胞瘤患者,患者中位年龄为43岁(31~69岁)。初始治疗中7例行单纯肿瘤剥除/单侧附件切除术,8例行子宫双附件切除术,3例行卵巢肿瘤全面分期术。患者术后5年和10年总生存率分别为94.4%和83.3%。共6例患者复发,中位复发时间为76个月。肿瘤直径>10cm、术中瘤体破裂是患者近期复发(<5年)的高危因素。低分化、术中瘤体破裂、高核分裂象(≥4/10HPF)是患者远期复发(≥5年)的高危因素。结论早期成人型卵巢颗粒细胞瘤整体预后好,高核分裂象、术中瘤体破裂可能是早期卵巢颗粒细胞瘤复发的潜在高危因素。     

卵巢颗粒细胞瘤临床与病理分析

１７年来收治了卵巢颗粒细胞瘤病人１９例。１９例中颗粒细胞瘤１４例，颗粒－卵泡膜细胞瘤５例。发病年龄９～７１岁，以更年期和绝经期妇女为多。临床表现子宫异常出血或月经失调，尤其是绝经后出血为多，青春期前出现典型性早熟。本瘤有晚期复发，预后较好的特点。本组较正存活率为８３．３％，５年存活率为７８．５％。本文认为：肿瘤超出卵巢本身者，无论年龄大小或有否生育，均应行卵巢癌根治术，尽可能切除转移病灶，术后尽早辅以化疗或放疗。     

卵巢颗粒细胞瘤:预后因素和结果

卵巢颗粒细胞瘤约占所有卵巢恶性肿瘤的2％～3％。一般认为其预后相对较好,属低度恶性。但仍有部分患者可在多年后发生远处转移。本文回顾了1953～1987后间收治的54例卵巢颗粒细胞瘤病例,对该肿瘤的某些危险因素如肿瘤分期、原发灶大小     

I期卵巢上皮性癌的预后因素

对我院１９６２年至１９８９年收治的６７例Ｉ期卵巢上皮性癌患者进行回顾性分析。按收治年代将其分为三组。结果：三组除采用的化学疗法（化疗）的方法不同外，其它治疗及患者的临床病理特点比较，差异无显著意义。６０年代（第一组）、７０年代（第二组）、８０年代（第三组）治疗的愚者预后随时间逐步改善，其５年生存率分别为４６％、８２％和９７％。第一组与第二组５年生存率比较，差异有非常显著意义（Ｐ＜０．００１）；第二组与第三组比较，差异有显著意义（Ｐ＜０．０５）。多因素分析显示，化疗及临床分期是影响预后的重要因素（Ｐ均＜０．０１），其次是病理分级（Ｐ＜０．０５）。多疗程联合化疗、Ｉａ期患者及肿瘤分化Ｉ、ＩＩ级患者预后好。本研究还就Ｉ期卵巢上皮性癌的化疗、手术准确分期及保留生育功能进行了讨论。     

卵巢交界性肿瘤的临床特征及治疗

目的明确卵巢交界性肿瘤（交界性瘤）的临床特征及治疗方法。方法对３５年来收治的７０例卵巢交界性瘤患者进行回顾性分析。结果患者年龄１６～７６岁,平均４５．６岁。组织类型粘液性４６例（６５．７％）,浆液性２１例（３０％）;临床分期Ⅰ期４６例（６５．７％）,Ⅱ期１例（１．４％）,Ⅲ期１１例（１５．７％）,无Ⅳ期患者。治疗后复发１２例（１７．１％）。ＣＡ１２５升高１１例（１１／２１）,癌胚抗原（ＣＥＡ）升高６例（６／１０）。治疗以手术为主,４５例术后接受辅助治疗。７０例中无瘤存活４５例,带瘤存活４例,死于交界性瘤１１例,死于其他原因１０例。１１例行单侧附件切除的Ⅰ期患者均无瘤存活。１６例术后有肿瘤残留并接受辅助治疗者中完全缓解２例。全组５年、１０年、２０年、３０年存活率分别为９０．０％、８７．１％、８７．１％和８５．６％。多因素分析显示,组织学类型、期别和术后肿瘤残留,是影响预后的主要因素。结论粘液性瘤所占比例明显高于浆液性瘤;手术治疗是交界性瘤有效的治疗手段,应力求将肿瘤完全切除;术后辅助治疗不能改善交界性瘤患者的预后;ＣＡ１２５和ＣＥＡ对于交界性瘤监测有一定意义     

卵巢幼年型颗粒细胞瘤四例临床分析

目的 探讨卵巢幼年型颗粒细胞瘤的诊断,治疗和预后。方法 回顾性分析自1983年至2002年间北京协和医院收治的4例卵巢幼年型颗粒细胞瘤的临床资料。结果 卵巢幼年型颗粒细胞瘤的发生率极低,主要发生在青少年及儿童,临床表现为盆腔实性包块伴胸腹水,4例患者雌二醇水平均在正常范围,手术病理分期为Ⅰ期。确诊主要依据病理检查,所有患者接受手术 化学药物治疗（化疗）。其中,2例呈高核分裂相的患者病情很快恶化,分别于发病后10和14个月死亡;2例低分裂相的患者现无瘤生存分别为32和25个月。结论 卵巢幼年型颗粒细胞瘤的诊断主要依据病理检查,核分裂相高者预后不良,治疗以手术为主,辅以化疗可能改善预后。     

Ⅲ期卵巢上皮性癌手术彻底性对预后的影响

目的通过分析接受肿瘤细胞减灭术的临床Ⅲ期卵巢上皮性癌患者的手术切净与基本切净的５年存活率，探讨残余肿瘤的大小对其预后的影响。方法自１９８２年１月至１９９５年６月，共收治临床Ⅲ期卵巢上皮癌１８６例，对其进行回顾性研究，并对结果进行统计学处理。结果４３例肿瘤切除干净者，其５年存活率为３２５％；７６例肿瘤基本切净者的５年存活率为２１４％（Ｐ＜００１）。基本切净者，３２例术后１年内化疗≥６疗程的５年存活率为２５２％，４４例术后１年内化疗＜６疗程的５年存活率为２０１％。结论肿瘤切净者的５年存活率高于肿瘤基本切净者的５年存活率。术后１年内化疗≥６疗程可提高基本切净者的５年存活率。     

卵巢无性细胞瘤60例临床回顾分析

我院自１９５９年５月至１９９２年１０月收治了纯型卵巢无性细胞瘤６０例。中位年龄２１岁。主要症状为腹部包块、腹痛、腹胀。Ｉ期患者３２例，Ⅱ期２例，Ⅲ期５例，复发或未控２１例。除１例仅行手术外，其余均接受手术加放射治疗和（或）化疗。９例死于本病，５年存活率达８５．１７％。辅助治疗采用放射治疗或化疗，两者的５年存活率差异无显著性，但对一些年轻且要求生育或晚期患者，术后采用化疗做为辅助治疗可能是更好的选择     

A long-term follow-up study of 176 cases with adult-type ovarian granulosa cell tumors

Objective

Because of rarity, indolent clinical course, and of most importance, small sample size studies of previous ovarian granulosa cell tumors (GCTs), this study was conducted to report the clinical characteristics and long-term outcomes of 176 pathologically confirmed GCTs.

Methods

Between 1984 and 2010, we retrospectively evaluated 176 patients from multiple medical centers in Taiwan.

Results

The mean age at the diagnosis was 46 years and nearly half of the patients (45.7%) were in their fourth or fifth decades of life. The most common symptoms included abdominal pain (28.5%), followed by irregular menstruation (16.7%). The mean tumor size was 10.4 cm. The stage distribution at diagnosis was stage I in 77.8% of patients, stage II in 5.1%, stages III-V in 6.1%, and unknown in 11% of patients. The median follow-up period was 60.7 months. The recurrence rate was 21%. The overall 5- and 10-year survival rates were 96.5% and 94.1%, respectively. In univariate analysis, initial stage, presence of residual tumor after initial surgery, need for adjuvant chemotherapy, and tumor size were associated with disease recurrence. In the multivariate analysis, only the presence of residual tumor after initial surgery and tumor size were significantly associated with recurrence.

Conclusions

The outcomes of patients with GCTs were good, with nearly to 95% of patients surviving 5 and 10 years. The prognosis was related to initial stage, presence of residual tumor after initial surgery, and tumor size (> 13.5 cm). Different surgical methods and/or adjuvant therapy appear not to affect the outcome.     

Management of recurrent juvenile granulosa cell tumor of the ovary

BACKGROUND: Juvenile granulosa cell tumors of the ovary are a rare form of neoplasm that makes up less than 5% of ovarian tumors in childhood and adolescence. About 90% are diagnosed in stage I with a favorable prognosis. More advanced stages (FIGO stages II--IV) have a poor prognosis. CASE: A patient was initially diagnosed at age 17 with FIGO stage IIIC disease and treated with a right salpingo-oophorectomy, debulking, and staging followed by six cycles of carboplatin and etoposide chemotherapy. Tumor recurrence in the liver and adjacent to the spleen occurred 13 months after completion of primary therapy. Aggressive surgical removal of tumor followed by six cycles of bleomycin and taxol as salvage chemotherapy resulted in 44 months of disease-free survival. On November 27, 2000, she had a cesarean delivery of a 2335-g normal male due to a breech presentation. Exploration revealed no evidence of tumor. CONCLUSION: This is the second case report of a patient with advanced juvenile granulosa cell tumor to become pregnant after apparently successful chemotherapy. These results are encouraging, but the best treatment for extensive and recurrent disease has yet to be determined.     

Early isosexual precocious pseudopuberty revealing a juvenile granulosa cell tumor in a six-year-old girl

Juvenile granulosa cell tumors of the ovary are a rare form of neoplasm that makes up less than 5% of ovarian tumors in childhood and adolescence. About 90% are diagnosed in stage I (FIGO) with a favorable prognosis, whereas those at higher stages have a less favorable outcome. The authors describe a juvenile granulosa cell tumor expressed by an early pseudopuberty occurring in a 6-year old child. Clinically, an endocrine syndrome was associated with a pelvic mass. Hyperoestrogenia and serum alphafoetoprotein level were biologically detected. Tumor was localized strictly to the ovary, so conservative surgery was applied and proved sufficient to remove all tumor tissue. Histological examination showed typical microscopic aspect of a juvenile granulosa cell tumor. The patient is well 14 years after surgery with normal growth and mental development.     

Ovarian carcinoma associated with pregnancy. A review of 9 cases

BACKGROUND: The purpose of this study was to review patients with ovarian cancer in pregnancy, the effectiveness of the available methods of treatment and their prognosis. METHODS: A retrospective review of all women diagnosed to have cancer of the ovary associated with pregnancy who delivered at the authors' hospitals between January 1976 and December 2000. The demography, clinical presentation, time and mode of diagnosis, treatment, pregnancy outcome and maternal survival were noted. RESULTS: The incidence of ovarian carcinoma in pregnancy in the series was 0.08/1000 deliveries. Of the 9 patients, 7 had epithelial cancers; 4 serous cystadenocarcinoma, 2 mucinous cystadenocarcinomas and one undifferentiated cancer. One patient each had dysgerminoma and granulosa cell tumor. Six patients were in FIGO stage Ia, one Ic, one IIa. One patient was in stage III. Five patients were treated by unilateral salpingo-oophorectomy during pregnancy. Three patients had total abdominal hysterectomy, bilateral salpingo-oophorectomy and omentectomy followed by chemotherapy. Debulking of the tumor was done in a patient in stage III with subsequent chemotherapy. This patient died 13 months from the time of diagnosis of the tumor. The overall 5-year survival rate in the series was 78% and 100% for stage Ia. CONCLUSIONS: Association of ovarian cancer with pregnancy is a rare occurrence. Early diagnosis and appropriate treatment offers the best prognosis for the patient. The higher survival rates in the series was attributed to a larger number of patients in stage I of the disease and 2 patients with a germ cell tumor and dysgerminoma which have the best prognosis. Aggressive postoperative chemotherapy also contributed to the better outcome.     

Granulosa cell tumor of the ovary: a population-based study of 37 women with stage I disease

OBJECTIVES: The goal of this work was to evaluate clinical and pathological findings, surgical procedures, and postoperative treatment in women with stage I granulosa cell tumor. METHODS: Data for 49 women with granulosa cell tumor were collected retrospectively. All pathological sections and findings were reviewed from diagnosis until recently. Follow-up data were collected from the general practitioner, hospital records, or death certificate. Fisher's exact test, Student's t test, Mann-Whitney test, and Kaplan-Meier survival analysis were applied, as appropriate. RESULTS: Thirty-seven women of median age 58 years (range, 33-82) were diagnosed in stage I. Follow-up time was 8 years (range, 8 months to 26 years). The estimated survival for stage I was 93% at 5 years, 84% at 10 years, and 62% at 20 years; the actual survival rates were 94, 82, and 62% after 5, 10, and 20 years, respectively. Primary treatment consisting of total abdominal hysterectomy and bilateral salpingo-oophorectomy was associated with improved survival (P < 0.05) and tended to be associated with longer relapse-free interval (P < 0.06). The 10-year survival rate was 40% in postmenopausal women operated conservatively and more than 90% for the extensively treated women (P < 0.05). Evidence of increased estrogen secretion was found more often in postmenopausal woman as compared with premenopausal women (P < 0.01) but did not affect survival. No pathological parameter correlated with prognosis. CONCLUSION: Granulosa cell tumor is a tumor of unquestionable malignant potential and has a tendency for late relapses. Long-time follow-up is recommended.     

Adult granulosa cell tumor of the ovary: 35 cases in a single Korean Institute

BACKGROUND: Adult granulosa cell tumor of the ovary is an uncommon neoplasm. The overall prognosis is favorable. The prognostic factors that are related to survival have not been well defined and are discussed in the literature amidst controversy. METHODS: Thirty-five patients diagnosed with adult granulosa cell tumor of the ovary were reviewed retrospectively. Demographic data, pathologic findings, treatments, and survival times were reviewed and analyzed for prognostic significance. RESULTS: Of the 35 cases, there were 30 cases representing stage I tumors, one case at stage II, four cases at stage III, and no cases at stage IV. The mean overall survival time of all patients was 140.3 months. The 5- and 10-year survival rates were 92.0% and 85.8% respectively. The FIGO stage was the only independent prognostic factor. CONCLUSIONS: Despite the small number of patients, the study showed that the less advanced stage is the only favorable prognostic factor of significance.     

Prognostic factors in ovarian cancer

The improvement in the treatment of ovarian cancer is based on the recognition of the prognostic factors. The 5-year survival rate of 174 patients with epithelial ovarian malignancies after primary operation at the University Department of Obstetrics and Gynecology in Ljubljana and treated with adjuvant therapy at the Institute of Oncology in Ljubljana in the period 1970-1980 was 29.3% (56% for stage I, 36% for stage II, 23% for stage III and 4.5% for stage IV). The amount of residual tumor after the primary operation was prognostically very important (5-year survival in stage III in cases of residual tumor less than 2 cm is 46.6%, in tumor greater than 2 cm only 18.6%). The histological type of tumor, considering the stage, was not important prognostically. On the contrary the grade of differentiation was prognostically very important even in advanced cases: 5 year survival for stage III in cases of well differentiated serous tumors was 61%, in moderately and poorly differentiated cases it was only 7%. Younger patients have better prognosis than older ones, because the tumors are better differentiated, too. Since ovarian cancers are diagnosed too late in 65% of cases in advanced stages, today all efforts should be focussed on early diagnosis, which is probably the only factors that can lead to the dramatic fall of the mortality rate.     

52例原发性阴道癌临床分析

Objective?To investigate the clinical features and prognostic factors of primary vaginal cancer. Methods?A total of 52 patients with complete pathological diagnosis and clinical follow-up data were selected from the first Affiliated Hospital of Zhengzhou University from January 2013 to January 2020. The general characteristics, different treatment methods and overall prognosis of the patients were analyzed. Results?the 1-year, 3-year and 5-year survival rates of 52 patients with primary vaginal cancer were 80.7%, 61.1%, and 48.1%, respectively. Among them, 28 patients (53.8%) had squamous cell carcinoma, and the median survival time was 92 months. There were 12 cases of malignant melanoma (23.0%), and the median survival time was 12 months The 5-year survival rates of early stage (stageⅠ+stageⅡ) and late stage (stageⅢ+stageⅣ) were 61.0% and 0.0%, respectively. Univariate analysis showed that FIGO stage, pathological type, tumor size, treatment mode, tumor growth stage and vaginal invasion length were related to the prognosis of patients (P<0.05). COX multivariate regression analysis showed that 2009 FIGO stage (P=0.002) and pathological type (P=0.000) were independent factors affecting the prognosis of patients with primary vaginal cancer.  The prognosis of different pathological types, such as squamous cell carcinoma and malignant melanoma, was significantly different (χ2=17.704, P=0.000). There was statistically significant difference between combined radiotherapy and chemotherapy with radiotherapy or chemotherapy alone (χ2= 4.017, P=0.045). Conclusion?The prognosis of primary vaginal cancer is related to pathological type and clinical stage. The earlier the clinical stage, the better the prognosis. The survival cycle of squamous cell carcinoma is much higher than that of malignant melanoma. The treatment is mainly radiotherapy, and the combined treatment of radiotherapy and chemotherapy is better than radiotherapy or chemotherapy alon.