Prognostic factors of patients with yolk sac tumors of the ovary

OBJECTIVE: Our purpose was to evaluate the prognostic factors in yolk sac tumors of the ovary. STUDY DESIGN: We performed a retrospective review of 47 patients with yolk sac tumors of the ovary from 1979 to 1997. RESULTS: Twenty-two patients had pure yolk sac tumors and 25 had germ cell tumors with yolk sac tissue as a component of the disease. The 5-year survival rate in stages I, II, III, and IV was 95%, 75%, 30%, and 25%, respectively. Patients with stage I disease had a more favorable prognosis than those with stage III and IV disease (P <.001). All patients who did not respond to chemotherapy died of this disease within 36 months of the first treatment. Chemotherapy regimens that included cisplatin gave better results than those without cisplatin (P <.05). The difference in prognosis was significant in cases in which the size of residual tumor was <2 cm in diameter (P <.01) and in cases in which ascites was either absent or <100 mL in volume (P <.05). Coexistence of other components of ovarian germ cell tumors in histologic specimens, preoperative serum alpha-fetoprotein level, fertility-sparing surgery, dissection of intrapelvic nodes, and p53 status had no significant correlation with the prognosis in this study. CONCLUSIONS: Staging and tumor-reductive surgery strongly affected the prognosis of this disease. Tumor-reductive surgery is advisable when ascites is minimal. Cisplatin-based chemotherapy after surgery was superior to chemotherapy without cisplatin; however, p53 status seemed to have no impact on chemosensitivity in yolk sac tumors of the ovary.     

Tumor chemoconversion following surgery, chemotherapy, and normalization of serum tumor markers in a woman with a mixed type germ cell ovarian tumor

BACKGROUND: Malignant germ cell tumors of the ovary are often curative after conservative surgery and adjuvant chemotherapy. Persistent tumors despite normalization of serum tumor markers may represent retroconversion to benign masses, but this is rare in ovarian tumors without teratoma elements. The management in such cases has not been defined. CASE: A young woman with a stage IIIC mixed germ cell ovarian tumor containing endodermal and dysgerminoma elements and elevated serum tumor markers underwent conservative surgery followed by chemotherapy. Residual tumor persisted on CT despite the normalization of serum tumor markers. The residual tissue was resected and contained benign tissue. CONCLUSIONS: In cases where masses persist and serum tumor markers normalize, attaining a histological diagnosis, and not chemotherapy, should be considered.     

卵巢恶性肿瘤患者保留生育功能手术的指征及处理原则

年轻的卵巢恶性肿瘤患者施行保留生育功能手术应限于早期且组织学类型较好者,如高、中分化上皮性肿瘤而非透明细胞瘤。术后一般不影响预后,且妊娠结局良好。而对中、晚期患者一般不推荐施行保留生育功能手术。卵巢交界性肿瘤患者年龄相对较轻,而且在诊断时多为Ⅰ期肿瘤,施行保留生育功能手术后妊娠成功率甚高。对卵巢交界性肿瘤患者甚至可行卵巢囊肿剥除术,其并不影响预后。生殖细胞肿瘤患者行保留生育功能手术的文献报道多为无性细胞瘤,手术成功率较高。而对晚期或其他类型生殖细胞肿瘤患者也有尝试保留生育功能手术,但这仅为个案报道,通常并不推荐施行保留生育功能手术,除非患者及家属有强烈意愿。对于施行保留生育功能手术的卵巢恶性肿瘤患者,由于具体情况不同,手术应因人而异行个体化治疗。     

Survival and reproductive function after treatment of immature ovarian teratoma.

We conducted a clinical and pathologic review of nine patients with immature ovarian teratoma. The histologic grade of the tumor seemed to be a reliable indicator of prognosis. Low stage and low grade immature ovarian teratomas have an excellent prognosis. Platinum-based chemotherapy has been confirmed to be effective in the management of patients with ovarian germ cell tumors. Low grade pure ovarian immature teratoma is a potentially curable disease and a fertility-sparing surgical approach is possible.     

Combination chemotherapy in the management of ovarian germ cell malignancies

Twenty-four patients with ovarian germ cell malignancies received combination chemotherapy in the present series. Fifteen patients received intensive vincristine, actinomycin-D, and cyclophosphamide therapy for 12 to 18 courses, and 13 are alive and free of disease 34 to 86 months later. One patient with a stage III pure endodermal sinus tumor and one patient with a stage III mixed germ cell tumor composed predominantly of endodermal sinus tumor elements failed vincristine, actinomycin-D, and cyclophosphamide therapy, but each transiently responded to cis-diamminedichloroplatinum, vinblastine, and bleomycin therapy. Nine patients subsequently were treated on a new protocol that used the intensive vincristine, actinomycin-D, and cyclophosphamide regimen for five to six courses for all stage I ovarian germ cell malignancies and cis-diamminedichloroplatinum, vinblastine, and bleomycin therapy for advanced stage tumors containing endodermal sinus tumor. Each patient on the new protocol is alive and free of disease 14 to 26 months later. Short-term intensive vincristine, actinomycin-D, and cyclophosphamide therapy is recommended for all stage I ovarian germ cell malignancies requiring adjuvant chemotherapy. Preservation of ovarian and reproductive function is appropriate in the present group of patients. Vincristine, actinomycin-D, and cyclophosphamide therapy is also recommended for biomarker negative advanced stage ovarian germ cell malignancies. Cis-diamminedichloroplatinum, vinblastine, and bleomycin therapy is recommended for advanced stage biomarker positive ovarian germ cell malignancies. Serial alpha-fetoprotein (AFP) titers accurately reflect the status of endodermal sinus tumor elements and may be used as a guide to discontinue treatment for patients with pure endodermal sinus tumor malignancies, obviating the need for second-look surgery.     

卵巢恶性生殖细胞肿瘤保留生育功能治疗及其价值评估

文章就卵巢生殖细胞肿瘤的发病特点和生物学特征进行阐述,探讨卵巢恶性生殖细胞肿瘤与上皮性卵巢癌在治疗原则和方法上的异同,以及保留生育功能手术对患者预后的影响,术后化疗对卵巢功能、生育功能和后代的影响等问题,强调卵巢生殖细胞肿瘤保留生育功能的可行性。     

Successful infertility treatment following fertility-sparing surgery and chemotherapy for ovarian immature teratoma: a case report and a literature review

Introduction  

Malignant ovarian germ cell tumors (MOGCTs) are highly chemosensitive tumors most commonly found in adolescent girls and young women. However, patients with advanced disease can now be successfully cured with fertility-sparing surgery and adjuvant chemotherapy, resulting in childbearing.     

卵巢非上皮性恶性肿瘤生育力保护

卵巢非上皮性恶性肿瘤约占卵巢肿瘤的10%，且多发生于年轻女性，手术和放化疗虽然能够使患者获得生存机会，但常带来不同程度的生育功能损害，造成其生理及心理上的痛苦，所以在改善卵巢恶性肿瘤患者生存率的同时，尽可能保护患者的生育力成为治疗中的重要问题。卵巢非上皮性癌尤其是恶性生殖细胞肿瘤保留生育功能治疗的效果良好，文章就卵巢非上皮性恶性肿瘤保护生育力的手术治疗、术后辅助治疗的实施及辅助生殖技术的应用等问题进行阐述。     

卵巢卵黄囊瘤诊疗进展

卵巢卵黄囊瘤(OYST)又称卵巢内胚窦瘤(OEST),属卵巢生殖细胞恶性肿瘤(MOGCT),发生率低,多见于儿童及青年女性,恶性程度高,生长迅速,易早期转移,预后差。甲胎蛋白(AFP)及磷脂酰肌醇3(glypican-3)是OYST重要的免疫组织化学标志物,铂类为基础的化疗药物显著提高了患者预后生存。因OYST对化疗药物敏感,保留生育功能是其手术原则,即使是对于分期较高的患者也可保留生育功能。手术+术后3~4周期辅助化疗(博来霉素、依托泊苷、铂类)系OYST的标准治疗方法。妊娠期合并OYST者少见,术后可以继续妊娠,孕期需要辅助化疗,但会增加胎儿畸形概率及孕妇死亡风险。肿瘤的组织类型、化疗方案种类的选择、肿瘤的分期、非满意的肿瘤细胞减灭术、术前血清AFP值及术后AFP下降值可对预后有影响,但手术方式的选择对患者预后影响不大。微创技术、辅助生殖技术及化疗期间卵巢功能的保护可使MOGCT患者获得益处。     

Menstrual function and childbearing potential after fertility-sparing surgery and platinum-based chemotherapy for malignant ovarian germ cell tumours

Malignant ovarian germ cell tumours (MOGCT) account for 5% of all ovarian malignancies. Their elevated chemosensitivity, the frequent unilaterality and the young age of patients have strongly supported the conservative surgery as the standard approach, often followed by adjuvant platinum-based chemotherapy. The risk for recurrence is not affected by the performance of conservative versus radical surgery. During chemotherapy 50% of patients become amenorrhoeic but more than 95% of them resume normal menses after treatment completion. Literature has reported several healthy babies born after fertility-sparing surgery with or without chemotherapy for MOGCT. The incidence of miscarriages is in the normal range, whereas malformation rate is slightly higher compared to general population, without any difference between chemotherapy-treated and -untreated patients. Therefore, young women with MOGCT must be reassured of their excellent chances of survival and fertility preservation following conservative surgery and adjuvant platinum-based chemotherapy.     

卵巢恶性生殖细胞肿瘤预后及生育状况分析

目的:探讨卵巢恶性生殖细胞肿瘤(MOGCTs)的临床特点、5年累积生存率以及行保留生育功能手术及化疗后患者的月经及生育状况。方法:采用回顾性分析法对我院1999年5月至2009年10月收治的34例MOGCTs患者的临床资料进行分析。结果:患者发病中位年龄28.5岁,34例患者中行根治性手术13例,行保留生育功能手术21例。单纯无性细胞瘤7例,非无性细胞瘤27例。26例患者术后补充化疗,其中行保留生育功能手术并化疗18例。化疗以博来霉素+依托泊苷+顺铂方案(BEP方案)及顺铂+长春新碱+博来霉素方案(PVB方案)为主。共随访9～146月,平均随访53.7±37.3月,失访4例,死亡3例,5年累积生存率为89%。临床观察指标中仅组织学分级为Ⅰ级的患者5年累积生存率(100%)高于Ⅱ～Ⅲ级(73%),差异有统计学意义(P=0.02),而各种手术类型、手术病理不同分期和不同组织学类型间的比较,差异均无统计学意义(P>0.05)。18例保留生育功能患者化疗后,月经异常发生率为83.3%(15/18),化疗结束后2～4月开始逐渐恢复。有生育计划的6例患者,共获得妊娠4例,其中3例自然妊娠,1例助孕后妊娠,共娩出健康新生儿3例。结论:MOGCTs总体预后较好,PVB、BEP方案是有效的化疗方案,化疗对行保留生育功能治疗患者卵巢功能的影响是可逆的,对于有生育要求的患者可行保留生育功能治疗并获得满意妊娠。     

卵巢卵黄囊瘤手术和化疗后自然周期体外受精-胚胎移植成功分娩一例并文献复习

卵巢卵黄囊瘤属卵巢恶性生殖细胞肿瘤,占卵巢恶性肿瘤的1%。由于卵巢恶性生殖细胞肿瘤多见于儿童及年轻女性,故保存生育能力是关键。卵巢卵黄囊瘤对化疗药物敏感,手术联合术后辅助化疗是标准治疗方案。对于对侧卵巢和子宫未受肿瘤累及,并且有生育需求的患者均应行保留生育功能的手术。但肿瘤本身、手术和放化疗均可能造成患者不孕,术后可能需要借助辅助生殖技术助孕,本文通过1例卵巢卵黄囊瘤患者手术和术后化疗后行自然周期-体外受精-胚胎移植(NC-IVF-ET)的个案报道和文献复习,探讨卵巢卵黄囊瘤患者的生育助孕策略。     

Ovarian,fallopian tube and primary peritoneal cancer: an overview

Ovarian, fallopian tube and primary peritoneal cancer has the poorest survival outcomes of all gynaecological malignancies. The majority of women present with advanced stage, high grade disease following a period of generalized abdominal symptoms. There is currently no effective screening programme. Diagnosis is based on imaging and histology. Stratification of adnexal masses into benign and malignant categories has helped ensure patients are appropriately referred to the gynaecology oncology team. The mainstay of treatment is both surgery and chemotherapy, with removal of all residual disease being one of the most important prognostic factors. Recent advances in targeted therapies are also beginning to improve outcomes.Less common types of ovarian cancer, such as sex-cord stromal tumours and germ cell tumours are generally found to affect younger women and have an improved prognosis. They present with early stage disease, are amenable to fertility-sparing surgery and, in the case of germ-cell tumours, are often exquisitely chemotherapy sensitive.     

165例卵巢恶性肿瘤不全分期术后行再分期手术必要性的临床初探#br#

Objective?To investigate the necessity of the re-staging operation after incomplete staging of epithelial cancer, ovarian malignant germ cell tumor and sex cord stromal tumor. Methods?A retrospective analysis was made on 165 ovarian cancer patients with surgical stageⅠA~ⅠC after incomplete staging operation who underwent re-staging operation in the First Affiliated Hospital of Zhengzhou University from January 2013 to January 2021. There were 85 cases in the epithelial carcinoma group, 31 cases in the malignant germ cell tumor group and 49 cases in the malignant sex cord stromal tumor group. Results?The rate of benefit from re-staging operation (surgical-pathological staging upgraded after re-staging operation) was 36.47% (31/85) in the epithelial cancer group, which was significantly higher than that in the germ cell tumor group (9.68%, 3/31) and sex cord stromal tumor group (4.08%, 2/49), the difference was statistically significant (P<0.05). The rates of benefit from re-staging operation among epithelial cancer, germ cell tumor and sex cord stromal tumor patients who had no residual impression tumor in incomplete staging operation are 33.33%(27/81), 3.44%(1/29) and 0%(0/47), which are significantly lower than that in the patients who had residual impression tumor in incomplete staging operation (P<0.05); The rates of benefit from re-staging operation among epithelial cancer, germ cell tumor and sex cord stromal tumor patients who had no positive imaging findings before re-staging are 34.15%(28/82), 3.44%(1/29) and 2.08%(1/48), which are significantly lower than that in the patients who had positive imaging findings before re-staging (P<0.05). Conclusion?The epithelial ovarian carcinoma with early surgical stage in incomplete staging operation should be treated with re-staging surgery after incomplete staging surgery; When there are residual tumor in incomplete staging operation or positive imaging findings before re-staging in the early surgical stage germ cell tumors and in the early surgical stage sex cord stromal tumors, it is necessary to perform re-staging surgery for them.     

Clinical review of 55 cases of malignant ovarian germ cell tumors

PURPOSE OF INVESTIGATION: A retrospective analysis of 55 cases of malignant germ cell tumors in a 20-year period was done to evaluate the impact of conservative surgery and adjuvant treatment on survival and fertility. METHODS: Fifty-five cases of malignant ovarian germ cell tumors (MOGCTs) were studied. Mean age was 22 years. Dysgerminoma was the most common histotype (45%). RESULTS: Thirty-nine patients (71%) presented with FIGO surgical Stage I disease. Fertility-sparing surgery was performed in 39 (71%) women. Postoperative systemic chemotherapy was administered to 40 women (73%), 27 (68%) had received conservative treatment. One woman developed renal failure after the first cycle of chemotherapy and died a few days thereafter and there was one case of bleomycin-induced death due to pulmonary fibrosis. There were eight (14.5%) clinical recurrences. Overall survival rate for relapsing women was 75% (6/8). The recurrence rate for women treated conservatively was 15%, and it was 13% for those treated radically. With a median follow-up of 129 months the overall survival rate for the entire study-population was 90.9%. Eleven pregnancies occurred in 36 women treated with fertility-sparing surgery who were of child-bearing age. CONCLUSION: The management of MOGCTs with fertility-sparing surgery is a safe, practicable treatment option. The majority of these patients can retain normal ovarian function and reproductive potential after chemotherapy treatment.     

青少年卵巢肿瘤的临床病理分析

目的:探讨青少年卵巢肿瘤的临床病理特点。方法:回顾性分析67例20岁以下的青少年卵巢肿瘤患者的临床表现、诊断、病理和治疗。结果:临床症状以腹痛、腹部包块为主,肿瘤扭转率高。良性肿瘤41例,交界性3例,恶性23例;组织学类型以生殖细胞肿瘤最多。恶性肿瘤中65.2%为FIGOI期。除8例恶性患者进行了肿瘤细胞减灭术外,其余59例均进行了保留生育功能的手术。15例恶性肿瘤患者术后化疗。单因素分析显示仅化疗方案影响生存期,BEP优于VAC。结论:青少年卵巢肿瘤的临床病理特点与成人不同,首选保留生育功能的手术,BEP是恶性患者的一线化疗方案。     

Prolonged survival following salvage surgery for chemorefractory ovarian immature teratoma: a case report and review of the literature

BACKGROUND: Data regarding salvage surgery for ovarian immature teratoma (IT) are lacking despite its established role in the management of chemorefractory testicular germ cell tumors. In this report, a case of advanced IT that was salvaged by secondary cytoreduction following failure of both primary therapy and salvage chemotherapy is described, and the available literature is reviewed. CASE: A 28-year-old patient underwent primary cytoreductive surgery followed by platinum-based chemotherapy for stage IIIC, grade 3, ovarian IT. Second-line chemotherapy was administered after residual disease was identified at second-look surgery. Following failure of salvage chemotherapy, aggressive secondary debulking resulted in long-term disease-free survival of over 48 months. CONCLUSION: There appears to be a distinct role for salvage surgery in selected cases of chemorefractory IT. More studies are needed to further define the subset of patients who benefit most from this management approach.     

Aggressive chemosurgical debulking in patients with advanced ovarian cancer

From July 1986 to June 1989, 43 evaluable patients with advanced ovarian cancer were treated on protocol with initial cytoreductive surgery, two courses of high-intensity intravenous Cytoxan (1000 mg/m2) and cisplatin (120-200 mg/m2) chemotherapy, and repeat debulking laparotomy in an effort to maximize response to a subsequent four cycles of intraperitoneal platinum-based chemotherapy. Two patients were stage IIIA, 2 stage IIIB, 28 stage IIIC, and 11 stage IV. Five tumors were grade 1, 9 grade 2, and 29 grade 3. Thirty-eight (88%) patients had bulky tumor (5-25 cm) found at first laparotomy; 25 of these had greater than 1-cm residual after initial debulking. Following two cycles of intensive intravenous chemotherapy 18 of these 25 had greater than 1-cm disease found at second laparotomy; 12 of 18 underwent secondary cytoreduction to less than 1 cm. Thus, 30 of these 38 (79%) patients entered the intraperitoneal phase of the protocol with less than 1-cm disease. Four patients had 2- to 5-cm tumor at initial laparotomy; two of four were debulked to less than 1-cm residual. All four were found to have less than 1-cm disease at second laparotomy. This combination regimen was well tolerated. There was one treatment-related death. In sum, 42 of 43 patients had tumor greater than 2 cm at staging laparotomy and 38 (88%) had large, bulky disease (5-25 cm); 34 of 43 (79%) entered the intraperitoneal phase of the protocol with optimal (less than 1-cm) disease. Aggressive chemosurgical cytoreduction in patients with bulky advanced ovarian cancer can leave a large proportion of patients with minimal residual disease and maximize their chances of responding to subsequent intraperitoneal chemotherapy.     

Malignant germ cell tumors of the ovary

OBJECTIVE: To evaluate the efficacy of adjuvant therapy for ovarian germ cell tumors. METHODS: We reviewed records of women who had malignant germ cell tumors of the ovary from 1977-1997. RESULTS: Seventy-two women had surgical resections of malignant ovarian germ cell tumors and most received adjuvant therapy. Fifty-six women (78%) presented with stage I disease, and 16 (22%) had more advanced disease. Tumor subtypes included dysgerminoma (n = 20), yolk sac tumor (n = 8), immature teratoma (n = 29) and mixed germ cell tumor (n = 15). Surgical management of the 56 with stage I disease consisted of total abdominal hysterectomy, bilateral salpingo-oophorectomy, and extensive surgical staging in ten women, whereas a conservative surgical approach, consisting of unilateral adnexectomy with or without comprehensive surgical staging, was adopted in later years (n = 46). Fifty-six women were treated with postoperative chemotherapy, predominantly platinum-based regimens. The 5-year actuarial survival rate was 93%. None of the 36 women who presented after 1984 have died of disease. CONCLUSION: These data confirmed that platinum-based adjuvant treatments allow most women with ovarian germ cell malignancies to have conservative surgery without compromising survival.     

Update on the management of ovarian germ cell tumors

Malignant germ cell tumors of the ovary are rare. In contrast to epithelial ovarian cancer, malignant germ cell tumors occur primarily in girls and young women. In addition, with the refinement of chemotherapeutic regimens in the last several decades, overall disease-free survival rates are >95%. Recent advances have focused on preservation of fertility in the management of patients with these tumors. In a girl or young woman who presents with a pelvic mass, a gynecologist must consider the diagnosis of an ovarian germ cell tumor in the initial workup. Elevated tumor markers may assist in determining the diagnosis preoperatively. Appropriate intraoperative decision making is crucial to adequately treat and stage the cancer without compromising future fertility. For patients with stage I dysgerminoma or stage I low grade immature teratoma, no additional chemotherapy is indicated. However, patients with stage I disease of other germ cell histologies, as well as advanced-stage disease of all germ cell histologies, require adjuvant treatment with bleomycin, etoposide and cisplatin.