卵巢卵黄囊瘤9例临床分析

目的：探讨卵巢卵黄囊瘤（ovarian yolk sac tumor，OYST）这一罕见疾病的诊断、治疗及预后。方法：对天津市中心妇产科医院2004年10月至2014年10月收治并经过手术和病理诊断确诊的9例OYST患者的临床资料进行分析、探讨和总结。结果：9例患者年龄17～60岁，中位年龄21岁。出现腹痛症状的患者5例，其余4例患者出现不同程度腹部坠胀现象，早期患者（6例IC期）占66.7％，晚期患者（1例ⅢA期，2例ⅢC期）占33.3％。手术前所有患者甲胎蛋白（alpha-fetoprotein，AFP）水平均高于正常值，对9例患者均施行手术治疗，对提出保留生育功能8例患者行保留生育功能手术方案，其中2例患者术后肿瘤未控，再次行根治性肿瘤细胞减灭术。1例绝经期患者直接行根治性手术。术后所有患者均采用BEP［博来霉素（bleomycin），依托泊苷（etopsoide），顺铂（platinol）］方案进行辅助化疗，2例再次肿瘤细胞减灭术患者因AFP下降不满意，其中1例改为IEP［异环磷酰胺（ifosfamide），依托泊苷（etoposide），顺铂（platinlo）］方案化疗，另1例改为VeIP方案化疗［长春新碱（vinblastine），异环磷酰胺（ifosfamide），顺铂（platinol）］。中位随访时间132月（80～178月），1例ⅢA期患者死亡，2例ⅢC期及6例IC期患者均无瘤生存，接受保留生育功能手术的6例患者中3例已正常生育。结论：卵巢卵黄囊瘤是一种来源于原始生殖细胞的高度恶性生殖细胞肿瘤，发病率极低，多见于低年龄的女性。血清AFP作为一种特异性较高的OYST标志物，对OYST的诊断具有肯定的价值。OYST对化疗非常敏感，对提出保留生育功能的患者在术中采取相应术式，术后可采用合理的BEP 方案进行辅助化疗。     

卵巢恶性混合型生殖细胞肿瘤诊断治疗分析（附18例）

目的：探讨卵巢恶性混合型生殖细胞肿瘤的临床特点、治疗及预后。方法：回顾我院1980年-2008年间18例卵巢混合性生殖细胞肿瘤病例资料,对诊断、治疗特点及预后进行回顾性研究。结果：发病年龄6-38岁,中位年龄20岁。腹痛、腹部包块、发热是常见症状。肿物多较大,平均直径15.7cm,病理包括2-3种生殖细胞成分混合,16例（88.9%）含有2种成分,2例（11.1%）含有3种成分。其中,卵黄囊瘤成分最多见,占83.3%,最常见的组合成份是未成熟畸胎瘤混合卵黄囊瘤（50%）。Ⅰ期9例（占50%）,Ⅱ期2例（占11.1%）,Ⅲ期7例（占38.9%）。Ⅰ-Ⅱ期病人5年生存率81.8%,Ⅲ期病人5年生存率42.9%,差异有显著性意义（P〈0.01）。保留生育功能手术12例,5年生存率75%。肿瘤细胞减灭术6例,5年生存率50%,两者差异无显著性意义。术后病人均进行化疗。在80年代及90年代初主要化疗方案是VAC方案（VCR＋KSM＋CTX）或PVC（PDD＋VCR＋CTX）方案,死亡率较高,5年生存率44.4%。1995年后主要是PVB/PVC＋PVB联合化疗方案,2例病人死亡,5年生存率66.7%。90年代末至今应用BEP方案（BLM＋VP-16＋PDD）,无一例死亡,5年生存率100%。结论：卵巢混合型恶性生殖细胞肿瘤患者腹痛、腹部包块是常见症状,病理类型多包括2-3种生殖细胞成分混合,卵黄囊瘤成分最多见,可以行保留生育功能手术,术后辅以规范的化疗是重要环节,化疗方案目前主要为BEP方案,有较高的5年生存率。     

顺铂联合化疗治疗卵巢恶性生殖细胞肿瘤

目的：探讨卵巢恶性生殖细胞肿瘤的治疗疗效及复发患者二线治疗。方法：对我院1958年11月－1998年12月312例卵巢恶性肿瘤中的154例接受顺铂方案化疗的卵巢恶性生殖细胞肿瘤结果进行分析。结果：154例卵巢恶性生殖细胞肿瘤的总生存率为74．7％，初治患者（I－Ⅲ期）92例，5年生存率为92．2％，其中66例（71．7％）保留生育功能，19例已正常生育20次。复发转移62例，5年生存率51．1％，8例保留生育功能。结论：为了提高卵巢恶性生殖细胞肿瘤生存率，首次手术时应正确分期，术后及时采用当前标准BEP方案作为一线化疗，连续3－6疗程。对复发患者，根据以往治疗情况尽早选用有效的二线方案化疗，有利于提高生存率。     

VPC联合化疗方案治疗卵巢恶性生殖细胞肿瘤的临床分析

为了探讨以顺铂为主联合化疗方案治疗卵巢恶性生殖细胞肿瘤的疗效,对61例卵巢恶性生殖细胞肿瘤患者中40例行保留生育机能手术,21例未保留生育机能。术后均采用VPC方案[长春新碱（VCR）、顺铂（DDP）和环磷酰胺（CTX）]进行化疗。VCR 2 mg,静脉推注,d1;DDP 60-80 mg/m^2,腹腔灌注,d2;CTX 600-800 mg/m^2,静脉滴入,d2。疗程间隔3-4周,依临床分期化疗3-6个疗程或肿瘤标志转阴后再巩固2个疗程。结果总的5年生存率为95.08%。40例保留生育机能的患者,8例已足月分娩,所生子女均发育正常。初步研究结果提示,VPC联合化疗方案是治疗卵巢恶性生殖细胞肿瘤的可行方案之一。     

端粒酶与卵巢上皮性癌化疗的相关性研究

目的检测卵巢上皮性癌患者化疗前后端粒酶活性的变化,探讨以顺铂为主的联合化疗对卵巢癌端粒酶活性的抑制作用。方法43例原发性卵巢上皮性癌患者行首次卵巢癌细胞减灭＋淋巴结清扫术,采用TRAP-PCR-银染法测定癌组织的端粒酶活性;RT—PCR法测定hTERT基因的表达;抗生素一生物素过氧化酶复合物（SP）免疫组化法检测hTERT蛋白的表达。术后予顺铂＋环磷酰胺（A组）、顺铂＋紫杉醇（B组）、顺铂＋环磷酰胺＋多柔比星（C组）全身化疗6．5（6～8）个疗程,选取临床检查和影像学检查未发现肿瘤残存、血液CA125水平在正常范围者30例（A组13例,B组11例,C组6例）行二次探查术,术中取原病灶周围组织活检,测定其端粒酶活性、hTERT基因及其蛋白的表达变化。随访3组患者的5年生存率。结果43例卵巢上皮性癌患者化疗前端粒酶活性的高低与病理类型、病理分级、FIGO分期无关,差异无统计学意义（P〉0．05）。化疗后3组化疗方案均有下调端粒酶活性的作用,化疗前后端粒酶活性阳性率分别为88．37％、36．67％,差异有统计学意义（P〈0．05）,其中B组下调端粒酶hTERT蛋白的表达较明显（P〈0．05）。化疗后hTERT蛋白的表达较化疗前明显下调（P〈0．05）,但患者5年生存率无明显提高（P〉0．05）。结论卵巢上皮性癌以顺铂为主的联合化疗具有抑制端粒酶活性的作用,顺铂＋紫杉醇化疗后端粒酶活性下调明显,但未能提高患者5年生存率,可能与化疗药物的耐药性有关。     

320例胃癌根治术后预后因素的回顾性分析

目的：胃癌根治术是胃癌治疗的主要手段，但手术的根治度并不是影响胃癌患者预后的唯一因素。本文旨在探求胃癌根治术后影响患者长期生存的预后因素。方法：分析我院1998年至2005年320例胃癌根治性切除病例的临床病理资料。其中D1式98例（30．6％），D2式205例（64．1％），D3式13例（4．1％），D4式4例（1．3％）.155例患者行围手术期腹腔活性碳加丝裂霉素化疗。除术后病理证实为Ⅰ期和不能耐受化疗者．所有病例均行术后常规化疗（草酸铂加替加氟加四氢叶酸）、以Kaplan—Meier方法进行生存率分析，Log—rank检验用于评估组间的统计学意义。结果：全组术后并发症14例。复发和转移25例；行腹腔化疗患者中有6例出现复发及转移。生存率曲线分析显示。手术方式（P〈0．001）、TNM分期（P〈0．001）、淋巴结转移范围（P〈0．001）、联合脏器切除（P〈0．001）以及腹腔化疗（P〈0．05）与术后远期生存有关，而性别、年龄、症状出现时间、手术根治度和病理类型则与胃癌术后患者的生存无关。结论：手术方式、TNM分期、淋巴结转移范围、联合脏器切除和腹腔化疗是影响胃癌根治术预后的重要因素。强调早诊旱治，施行以根治性手术为主的综合治疗模式，是提高胃癌术后生存率的关键。     

72例卵巢恶性生殖细胞肿瘤的治疗及预后

目的 总结72例卵巢恶性生殖细胞肿瘤的治疗及预后。方法 1978年至1991年我院共收治卵巢恶性生殖细胞肿瘤72例,占同期收治的卵巢恶性肿瘤总数的22.15％。Ⅰ期43例,Ⅱ期5例,Ⅲ期15例,Ⅳ期8例。实施以手术为主加化疗或/和放疗。结果 全组5年生存率54.2％,其中无性细胞瘤81.52％,未成熟畸胎瘤53.30％,混合性生殖细胞瘤33.33％,内胚窦瘤22.20％,胚胎癌0。结论 影响其愈后的诸因素中,除临床期别,病理类型外,恰当的手术切除范围,术后多疗程的联合化疗显得尤为重要。对年青需保留生育功能的无性细胞瘤患者,术后化疗取代传统的放疗较为妥当。     

影响卵巢上皮性癌手术加紫杉醇联合顺铂化疗疗效的相关临床病理因素分析

目的:探讨影响卵巢上皮性癌手术加紫杉醇联合顺铂化疗疗效的相关临床病理因素。方法:选取2014年1月至2016年3月于我院行手术治疗加紫杉醇联合顺铂化疗的296例卵巢上皮性癌患者进行资料分析,对所有患者进行3~24个月的随访,采用Logistic回归方程计算,观察影响卵巢上皮性癌手术加紫杉醇联合顺铂化疗疗效的相关临床病理因素。结果:本组296例患者客观缓解率（objective response rate,ORR）为70.95%,疾病控制率达到86.15%,本组296例患者随访6个月时,生存率为82.77%（245/296）,随访1年生存率为71.96%（213/296）,随访2年生存率为58.78%（174/296）。本次将ORR视为有效,PD+SD为无效,对比两组间的临床资料发现,两组在组织学分级、手术病理分期、大网膜切除、肿瘤细胞减瘤术的理想程度方面差异有统计学意义（P＜0.05）,将上述有差异资料带入Logistic回归方程计算,发现组织学分级、手术病理分期、大网膜切除、肿瘤细胞减瘤术均是影响卵巢上皮性癌的危险因素。结论:影响卵巢上皮性癌手术加紫杉醇联合顺铂化疗疗效的相关临床病理因素较多,临床应根据患者的实际情况采取个体化治疗,手术过程中应尽可能做到彻底除瘤,延长患者生存期限。     

卵巢无性细胞瘤27例临床分析

目的 探讨卵巢无性细胞瘤的合理治疗方案。方法 回顾性分析了10年间经我院治疗的卵巢无性细胞瘤27例的临床资料。按治疗特点不同分组,A组手术范围大,基本不考虑保留生育机能,术后以放疗为主;B组多行保守性手术,以患侧附件切除为主,术后辅以规范的化疗。比较两组5年生存率和患者月经及生育情况。结果 A组5年生存率为58.8％(10/17),B组5年生存率为90.0％(9/10),两组相比差异有显著性(P<0.05)。B组中6例现月经正常,3例已生育。结论卵巢无性细胞瘤应采取以手术为主辅以化疗的综合治疗,既可最大限度保留生育功能,又能提高5年生存率。在进行保留生育功能手术和处理时应注意手术的全面性、正规化疗的重要性和随访的长期性。     

30例儿童卵黄囊瘤临床预后因素分析

目的:对影响儿童卵黄囊瘤预后因素进行分析讨论.方法:自1989年到2002年随访30例,对年龄、性别、原发部位、Brodeur分期、血清AFP、化疗方案等进行多因素和单因素统计学分析.结果:Brodeur分期、化疗方案的选择是影响卵黄囊瘤2年无事件生存率的独立临床因素.Ⅰ到Ⅳ期的2年无事件生存率分别为76.92%、66.67%、40.00%和0:VAC及不规则化疗方案和铂类方案的2年EFS分别为18.18%和73.68%,有统计学差异.结论:儿童卵黄囊瘤的治疗为手术加辅助化疗的综合治疗,手术应以达到无肿瘤残留为目标.铂类方案的辅助化疗有助于提高疗效,但复发和转移病例的疗效仍有待提高.     

卵巢内胚窦瘤临床特点与预后相关因素分析

目的分析卵巢内胚窦瘤的临床病理学特点,以及Bc l-2在卵巢内胚窦瘤中的表达,探讨影响该病预后的相关因素。方法回顾性分析辽宁省肿瘤医院1984年1月至2007年12月收治的76例卵巢内胚窦瘤患者的临床病理学资料,分析Bc l-2在卵巢内胚窦瘤中的表达,了解各临床病理因素对预后的影响。结果Ⅰ、Ⅱ、Ⅲ及Ⅳ期卵巢内胚窦瘤患者的5年生存率分别为91.8%、88.9%、39.5%及25.0%。年龄、组织学类型、术前血清中甲胎蛋白值水平、是否保留生育功能的手术方式、术前肿瘤大小并不影响该病的预后。以铂类为基础的化疗方案,化疗疗程数〉3,残余瘤直径≤2 cm和腹水量≤100 mL是影响预后的因素。Bc l-2在不同病理类型间表达差异有统计学意义（P〈0.05）,但Bc l-2并不是影响预后的独立因素。结论临床分期,以铂类为基础的化疗方案,化疗疗程数,残余瘤直径和腹水量是影响预后的因素。     

The role of staging and adjuvant chemotherapy in stage I malignant ovarian germ cell tumors (MOGTs): the MITO-9 study

BackgroundSurgery followed by platinum-based chemotherapy is the standard of care for MOGCTs, except for stage IA dysgerminoma and stage IA grade 1 immature teratoma where surveillance only is recommended. The role of adjuvant chemotherapy and surgical staging is debated.Patients and methodsData from 144 patients with stage I MOGTs were collected among MITO centers (Multicenter Italian Trials in Ovarian Cancer) and analyzed.ResultsFifty-five (38.2%) patients were affected by dysgerminomas, 49 (34%) by immature teratomas, 26 (18.1%) by yolk sac tumors and 14 (9.7%) by mixed tumors. Seventy-three (50.7%) patients receive surgery plus chemotherapy, while 71 (49.3%) patients underwent surgery alone. The latter group included 32 dysgerminomas (14 IA–13 Ix, 3 IB, and 2 IC), 34 immature teratomas (20 1A–13 IA grade 1, 6 Ix, 1 IB, and 7 IC), 4 mixed tumors and 1 yolk sac tumor. Forty-four patients did not received chemotherapy, even if it would have been indicated by recommended approach. 94 (65.3%) patients received peritoneal surgical staging. Twenty-three (15.9%) developed a recurrence. Incomplete surgical staging was associated with recurrence (P < 0.05; OR 2.37) at Cox regression analysis. Seven patients died. Four patients were affected by yolk sac tumors, two by mixed tumors and one by immature teratoma. Five patients died for disease, one for acute leukemia and one for suicide. Prognostic parameter analyses showed that yolk sac component is a predictor for survival (P < 0.05). Five-years OS rates were 96.8% and 88.7% in the surgically staged and the incomplete staged group, respectively, while 93.8% and 94.1% in the standard treatment and in the surveillance group, respectively.ConclusionsThis study shows that surveillance seems not to affect survival; chemotherapy should be reserved for relapse resulting in high cure rate. Incomplete peritoneal surgical staging is associated with recurrence. Yolk sac histology worsens the prognosis.     

Clear cell carcinoma of the ovary: Is there a role of histology-specific treatment?

Several clinical trials to establish standard treatment modality for ovarian cancers included a high abundance of patients with serous histologic tumors, which were quite sensitive to platinum-based chemotherapy. On the other hand, ovarian tumor with rare histologic subtypes such as clear cell or mucinous tumors have been recognized to show chemo-resistant phenotype, leading to poorer prognosis. Especially, clear cell carcinoma of the ovary (CCC) is a distinctive tumor, deriving from endometriosis or clear cell adenofibroma, and response rate to platinum-based therapy is extremely low. It was implied that complete surgical staging enabled us to distinguish a high risk group of recurrence in CCC patients whose disease was confined to the ovary (pT1M0); however, complete surgical staging procedures could not lead to improved survival. Moreover, the status of peritoneal cytology was recognized as an independent prognostic factor in early-staged CCC patients, even after complete surgical staging. In advanced cases with CCC, the patients with no residual tumor had significantly better survival than those with the tumor less than 1 cm or those with tumor diameter more than 1 cm. Therefore, the importance of achieving no macroscopic residual disease at primary surgery is so important compared with other histologic subtypes. On the other hand, many studies have shown that conventional platinum-based chemotherapy regimens yielded a poorer prognosis in patients with CCC than in patients with serous subtypes. The response rate by paclitaxel plus carboplatin (TC) was slightly higher, ranging from 22% to 56%, which was not satisfactory enough. Another regimen for CCC tumors is now being explored: irinotecan plus cisplatin, and molecular targeting agents. In this review article, we discuss the surgical issues for early-staged and advanced CCC including possibility of fertility-sparing surgery, and the chemotherapy for CCC disease.     

Prognosis of Eight Chinese Cases of Primary Vaginal Yolk Sac Tumor with a Review of the Literature

Background: Primary vaginal yolk sac tumor is a rare malignancy in the pediatric population, and adiagnostic challenge and appropriate initial treatment remains unsolved. The aim of this study was to investigatethe clinicopathologic features, treatment and prognosis of this tumor. Materials and Methods: Eight cases ofprimary vaginal yolk sac tumor were reported with a literature review. Results: There were 4 pure yolk sactumor cases and four mixed germ cell tumors containing yolk sac tumor element, including two cases withembryonal carcinoma and two cases with embryonal carcinoma and dysgerminoma. Partial vaginectomy wasperformed in four cases and all patients received chemotherapy. 85 cases in literatures were reviewed and 9cases were misdiagnosed. Follow-up data was available in 77 cases and 5-year overall survival rate was 87.6%.5-year survival rate of biopsy with chemotherapy, conservative surgery with chemotherapy and radical surgerywith chemotherapy was 91.1%, 100% and 28.6%, respectively (p<0.001). Compared to cases without relapse ormetastasis after initial treatment, patients with relapse or metastasis had a shorter overall survival (35.6% vs96.6%, p<0.001). Conclusions: Mixed germ cell tumor containing yolk sac tumor element was not uncommonand partial vaginectomy may be a good choice for primary vaginal mixed yolk sac tumor type to eradicate localtumor cells and provide complete information for pathological diagnosis and postoperative adjuvant therapy.     

Treatment of nondysgerminomatous ovarian germ cell tumors: an analysis of 69 cases.

BACKGROUND: Combination chemotherapy has dramatically improved the prognosis of patients with nondysgerminomatous ovarian germ cell tumors (NDOGCT). However, guidelines are needed for the identification of patients at risk of relapse. METHODS: The authors performed a retrospective analysis of women with NDOGCT managed during the period 1970-1994 at the Royal Marsden Hospital and other hospitals of the London Gynaecological Oncology Group. RESULTS: Sixty-nine women were included; their median follow-up was 5.7 years (minimum, 12 months). The median age was 21 years (range, 4-44 years), with a histology of immature teratoma (IT) for 17 patients, endodermal sinus tumor (EST) for 20 patients, and mixed tumors for 32 patients. Thirty-five patients (51%) had Stage I disease. Nine patients with Stage I tumors were observed without further therapy (six with IT and three with mixed tumors), and one relapsed. Seven patients received non-platinum-based chemotherapy, and four relapsed. A total of 52 patients were treated with platinum-based chemotherapy, with relapse free and overall survival rates of 87% (95% confidence interval [CI], 73-93%) and 84% (95% CI, 70-91%), respectively. Of these patients, relapse was seen in 0 of 9 IT patients, 1 of 25 patients with mixed tumors, and 6 of 18 EST patients. With alpha-fetoprotein (AFP) > 1000 kU/L, relapse was seen in 6 of 18 patients compared with 1 of 33 relapses with lower AFP levels. In multivariate analysis, including all patients who received chemotherapy, AFP >1000 kU/L (P = 0.001) and non-platinum-based chemotherapy (P = 0.005) were associated with relapse. When only patients given platinum-based treatment were considered, EST histology (P = 0.003) and AFP >1000 kU/L (P = 0.003) were associated with relapse in univariate analysis; however, these factors were linked. No malignant tumor was found at second-look surgery performed on 24 patients. Of 26 women assessable for fertility, 24 subsequently recommenced regular menstrual function, and 11 patients had pregnancies. CONCLUSIONS: Platinum-based chemotherapy has been confirmed to be effective in the management of patients with NDOGCT. Relapses were principally seen among patients with AFP >1000 kU/L or pure EST histology. Efforts to improve outcome need to focus on patients with EST, whereas less intensive management strategies may be appropriate for some patients with IT.     

Survival and reproductive function of 52 women treated with surgery and bleomycin,etoposide, cisplatin (BEP) chemotherapy for ovarian yolk sac tumor

BackgroundOvarian yolk sac tumor (YST) is a very rare malignancy arising in young women. Chemotherapy has dramatically improved the prognosis. Current treatment consists of surgery followed by bleomycin, etoposide, and cisplatin (BEP) chemotherapy. However, given the rarity of this tumor, ovarian YST-specific survival and outcome after such treatment are not precisely known.Patients and methodsThis report concerns prospectively recorded cases that were either treated at Institut Gustave Roussy (Villejuif, France) or referred there for advice about therapy. From 1990 to 2006, 52 patients underwent surgery followed by BEP chemotherapy. Data on patient characteristics, treatment, survival, and fertility outcome were analyzed to assess treatment efficacy and gonadal toxicity after achieving a complete remission.ResultsThirty-five patients had stage I/II tumors while 17 patients presented with stage III/IV disease. With a median follow-up of 68 months, the overall 5-year survival and disease-free survival rates were 94% and 90%, respectively. Forty-one women underwent fertility-sparing surgery. Pregnancy was achieved in 12 of 16 (75%) women who attempted conception. Overall, 19 pregnancies have been recorded.ConclusionsBEP chemotherapy following fertility-sparing surgery is a very effective treatment of ovarian YSTs. Most of the patients who attempt conception after complete remission will have children.     

Treatable Subsets in Cancer of Unknown Primary Origin

The purpose of this study was to investigate the treatable subsets in cancer of unknown primary origin (CUP). Fifty patients (27 males and 23 females; median age, 53 years) with CUP diagnosed between April 1992 and June 1999 were analyzed retrospectively. Of the 50 patients, 39 received chemotherapy: platinum-based in 31, non-platinum-based in 4, and clinical trials of new agents in 4. Of the 39 patients, 13 (33.3%; 95% confidence interval: 19.1–50.2%) showed objective responses, with 4 complete responders. Patients with poorly differentiated carcinomas in whom p-subunit of human chorionic gonadotropin (β-HCG) was elevated more than 10 mlU/ml and female patients with peritoneal adenocarcinomatosis achieved high response rates (83.3% and 80%, respectively) with platinum-based chemotherapy, as compared with only a 15.3% response rate in the remaining patients. Platinum-based chemotherapy provided promising results in patients with poorly differentiated carcinomas and in female patients with peritoneal adenocarcinomatosis. Significantly elevated serum levels of β-HCG in patients with poorly differentiated carcinoma might predict a better response to platinum-based chemotherapy. However, the investigation of novel chemotherapeutic approaches is warranted for other groups of patients with CUP.     

Treatable subsets in cancer of unknown primary origin.

The purpose of this study was to investigate the treatable subsets in cancer of unknown primary origin (CUP). Fifty patients (27 males and 23 females; median age, 53 years) with CUP diagnosed between April 1992 and June 1999 were analyzed retrospectively. Of the 50 patients, 39 received chemotherapy: platinum-based in 31, non-platinum-based in 4, and clinical trials of new agents in 4. Of the 39 patients, 13 (33.3%; 95% confidence interval: 19.1 - 50.2%) showed objective responses, with 4 complete responders. Patients with poorly differentiated carcinomas in whom beta-subunit of human chorionic gonadotropin (beta-HCG) was elevated more than 10 mIU / ml and female patients with peritoneal adenocarcinomatosis achieved high response rates (83.3% and 80%, respectively) with platinum-based chemotherapy, as compared with only a 15.3% response rate in the remaining patients. Platinum-based chemotherapy provided promising results in patients with poorly differentiated carcinomas and in female patients with peritoneal adenocarcinomatosis. Significantly elevated serum levels of beta-HCG in patients with poorly differentiated carcinoma might predict a better response to platinum-based chemotherapy. However, the investigation of novel chemotherapeutic approaches is warranted for other groups of patients with CUP.     

Surgery for borderline tumor of the ovary

The five-year survival for women with Stage I borderline tumors is about 95% to 97%, but because of late recurrence the 10-year survival is only 70% to 95%. The five-year survival for Stage II-III patients is 65% to 87%. A more correct staging procedure, classification of true serous implants, and agreement on how the presence of gelatinous ascites in mucinous tumors contributes to cancer stage might change the distribution of stage and survival data by stage for women with borderline tumors in the future. Independent prognostic factors for patients with borderline tumors without residual tumor after primary surgery are: DNA ploidy, morphometry, International Federation of Gynecology and Obstetrics (FIGO) stage, histologic type, and age. Different types of surgery and chemotherapy were not independent prognostic factors. Questions which should be addressed include the following: 1) Have patients with borderline tumors been over treated in general, and how should these patients be treated? 2) In which group of patients is fertility-sparing surgery advisable? 3) Do patients with borderline tumors benefit from adjuvant treatment? And 4) How is the high-risk patient defined?     

Conservative surgery for malignant ovarian tumor in women of childbearing age

Background. The traditional operative procedures for the treatment of ovarian cancer have been simple total hysterectomy, bilateral salpingo-oophorectomy, and omentectomy. However, young patients who want to preserve fertility are occasionally encountered. This study was designed to assess the results of conservative surgical management for young women with stage I epithelial ovarian carcinoma or malignant germ cell tumor and to explore the indications for such surgical treatment. Methods. Fifty-eight patients aged under 35 years were treated for malignant ovarian tumors (germ cell tumor, n = 20; epithelial tumors, n = 38) between 1971 and 1996. We studied all 20 patients with germ cell tumors and 22 pa-tients with stage I epithelial tumors; we excluded the 12 patients with stage II and more advanced disease and the 4 patients with stage I clear cell carcinoma, because these patients had poor prognoses. Eleven of the 22 patients with stage I epithelial tumors and 8 of the 20 patients with germ cell tumors received conservative surgery (conservative surgery group); the remaining 23 patients underwent radical surgery, including hysterectomy and bilateral salpingo-oophorectomy (radical surgery group). The overall survival rates of the two groups were compared, and ovarian function and pregnancy outcome were evaluated in the conservative surgery group. Results. Of the patients with malignant epithelial tumor who were treated with conservative surgery, 3 patients with stage Ic mucinous adenocarcinoma died 1 year and 8 months, 7 years and 6 months, and 8 years, respectively, after the initial surgery. The 10-year survival rate was 65% for the conservative surgery group and 91% for the radical surgery group. All patients with stage Ia epithelial tumors in both groups survived, and there were no differences in survival curves between the two groups among the patients with stage Ic epithelial tumors. All patients with germ cell tumors in the conservative surgery group survived. Their survival rate, however, was not significantly better than that in the radical surgery group. All patients with germ cell tumors who received platinum-based chemotherapy survived and had a significantly better survival rate than those who received non-platinum-based regimens (P < 0.05). All the patients in the conservative surgery group received postoperative chemotherapy; 10 of these patients had transient ovulation failure after the completion of chemotherapy, although a normal menstrual cycle was restored within 1 year. Of the 10 patients who wished to have babies, 6 became pregnant, and they have had a total of 11 children. Conclusion. Conservative surgery is feasible in patients with stage Ia epithelial carcinoma and germ cell tumor. Postoperative chemotherapy suppressed ovarian function in these patients, but only for a brief period. Received: January 5, 1999 / Accepted: October 27, 1999