巢恶性生殖细胞肿瘤的手术治疗与保守性手术的选择

巢恶性生殖细胞肿瘤的手术治疗与保守性手术的选择１００７３０北京协和医院黄惠芳卵巢恶性生殖细胞肿瘤多发生于年轻的妇女及幼女，其恶性程度大，死亡率高。近些年来由于找到了有效的化疗方案，使预后大为改观。通过ＰＶＢ或ＢＥＰ联合化疗，可使卵巢内胚窦瘤及未成熟畸...     

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     

复发性耐药性卵巢恶性生殖细胞肿瘤的治疗

恶性生殖细胞肿瘤治疗关键是规范化,包括手术切除肿瘤、手术病理分期、术后规范化疗,强调及时、足量、正规,可争取90%以上甚至100%的持续缓解率。初次化疗不规范,病情可能持续不缓解或复发。对于复发性恶性生殖细胞肿瘤,再次肿瘤细胞减灭术有减轻瘤负荷的作用,为术后的化疗奠定基础。复发性卵巢恶性生殖细胞肿瘤术后的二线化疗也至关重要。化疗药物应个体化,化疗的疗程数也强调个体化,有阳性肿瘤标志物的患者治疗应持续至肿瘤标志物降至正常后2个疗程。无阳性的肿瘤标志物的患者治疗应持续4~6个疗程。无性生殖细胞瘤和未成熟畸胎瘤对再次化疗或手术仍有效,预后好。卵黄囊瘤则效果很差。卵巢胚胎癌及原发绒癌很少见,治疗经验少。     

卵巢恶性生殖细胞肿瘤患者保留生育功能65例临床分析

卵巢恶性生殖细胞肿瘤是一种主要发生于儿童及年轻妇女的恶性肿瘤。随着联合化疗的应用和不断改进,卵巢恶性生殖细胞肿瘤的生存率逐渐提高。在大部分患者可获得长期存活的同时,对保留生育功能的要求变得越来越迫切。本研究回顾分析我院收治的６５例卵巢恶性生殖细胞肿瘤患者保留生育功能的情况,以探讨保留生育功能的条件及治疗措施。一、资料与方法１９５８年５月至１９９６年１１月,我院共收治卵巢恶性生殖细胞肿瘤２７６例,其中保留生育功能６５例。１．年龄及婚育情况：初诊时患者中位年龄１８岁,年龄最小５岁,最大３５岁;＜２０…     

42例卵巢恶性生殖细胞肿瘤临床特征及预后分析

目的:探讨卵巢恶性生殖细胞肿瘤的临床特征与预后的关系。方法:收集我院2006年8月至2012年2月收治的42例卵巢恶性生殖细胞肿瘤的临床资料,分析其肿瘤类型、分期、治疗方案等预后相关因素,研究其临床特征与不良预后的关系。结果:42例卵巢恶性生殖细胞肿瘤包括混合性生殖细胞肿瘤16例(38.1%)、未成熟畸胎瘤12例(28.6%)、无性细胞瘤6例(14.3%),卵黄囊瘤4例(9.5%)、绒毛膜癌1例(2.4%)及胚胎癌1例(2.4%)等。42例患者全部进行手术治疗,其中30例在初次手术中保留了生育功能,34例在术后给予BEP方案(博来霉素+依托泊苷+顺铂)或BVP方案(博来霉素+长春新碱+顺铂)化疗。2年生存率97.5%(39/40),死亡1例(Ⅳ期混合性生殖细胞肿瘤),复发率37.5%(15/40),混合性生殖细胞肿瘤复发占66.7%(10/15);5年生存率88.2%(15/17),死亡2例(均为恶性混合性生殖细胞肿瘤)。不同病理分期、肿瘤直径、肿瘤类型和手术方式的5年生存率比较,差异均无统计学意义(P0.05)。结论:保留生育功能手术及规范化的BEP或BVP方案化疗,5年总体生存率较高,但混合性生殖细胞肿瘤预后相对较差。卵巢恶性生殖细胞肿瘤的病理分期、肿瘤直径及肿瘤类型与生存率的关系还需进一步研究。     

少女生殖道恶性肿瘤的治疗

目的 探讨少女生殖道恶性肿瘤的临床特点、治疗方法和疗效。方法 回顾性分析27例少女生殖道恶性肿瘤的临床资料。结果 患儿的年龄为2－12岁,平均6．5岁。卵巢恶性肿瘤23例,其中卵巢恶性生殖细胞肿瘤21例,占77．8％;性腺外恶性肿瘤4例,包括阴道内胚窦瘤2例,阴道和盆腔横纹肌肉瘤各1例。卵巢恶性肿瘤的临床表现主要为腹痛和腹部包块,分别为77．8％和74．1％;而阴道恶性肿瘤的临床表现,主要为阴道流血和阴道肿块。91．3％（21／23）的患儿仅行患侧附件切除术,保留了子宫和对侧卵巢。少女生殖道恶性肿瘤对化学治疗（化疗)十分敏感,术后根据高危因素不同,分别给予顺铂、长春新碱、博莱霉素（PVB）方案,顺铂、鬼臼素、博莱霉素（PEB）方案或长春新碱、更生霉素、环磷酰胺（VAC）方案化疗。在平均为47．4个月的随诊期内,生存率达71．4％。结论 卵巢恶性生殖细胞肿瘤对化疗十分敏感,应作为主要的治疗手段。手术的原则应保留生育功能。     

晚期卵巢上皮性癌腹膜后淋巴结清的合理选择

目的 探讨腹膜后淋巴结清除术在晚期卵巢上皮性癌治疗中的合理应用。方法 对４２例晚期卵巢上皮性癌行腹膜后淋巴结清除术,根据术后钱留灶大小成分两组。Ａ组：２６例,残留癌灶直径２〈ｃｍ;Ｂ组：１６例,残留癌灶直径≥２ｃｍ。术后两组进行的联合化疗基本相同。临床分期和病理分级基本相同。结果 Ａ组５年生存率５３．８％（１４／２６）,Ｂ组５年生存率１２．５％（２／１６）,两组比较,差异有显著意义（Ｐ〈０．００１     

卵巢无性细胞瘤合理治疗的探讨（附34例分析）

卵巢无性细胞瘤合理治疗的探讨（附３４例分析）李胜泽，李玲卵巢无性细胞瘤是多见于年轻女性的恶性生殖细胞肿瘤．我院自１９８０年～１９９０年共收治３４例，占同期收治卵巢恶性肿瘤的７．８％．本文通过３４例资料回顾性总结分析，探讨合理的治疗．以提高患者的生存质...     

晚期卵巢上皮性癌腹膜后淋巴结清除的合理选择

目的探讨腹膜后淋巴结清除术在晚期卵巢上皮性癌治疗中的合理应用。方法对４２例晚期卵巢上皮性癌行腹膜后淋巴结清除术,根据术后残留灶大小分成两组。Ａ组：２６例,残留癌灶直径＜２ｃｍ;Ｂ组：１６例,残留癌灶直径≥２ｃｍ。术后两组进行的联合化疗基本相同。临床分期和病理分级基本相同。结果Ａ组５年生存率５３８％（１４／２６）,Ｂ组５年生存率１２５％（２／１６）,两组比较,差异有极显著意义（Ｐ＜０．００１）。结论晚期卵巢上皮性癌在残留癌灶直径＜２ｃｍ前提下行腹膜后淋巴结清除术,可以明显提高生存率。如残留癌灶直径≥２ｃｍ时,不必行腹膜后淋巴结清除术。     

对卵巢生殖细胞恶性肿瘤当代处理的评价

近10～15年来,卵巢生殖细胞恶性肿瘤的预后有了非常显著的改观.若仅行手术治疗或手术加放疗,其预后极差.只有纯粹的无性细胞瘤及某些未成熟性畸胎瘤可能预后较好.而由于用了联合化疗使得恶性生殖细胞肿瘤提高到接近于90%的生存率.对卵巢生殖细胞瘤最常用的联合化疗是长春新硷、放线菌素D及环磷酰胺(VAC)或氨甲喋呤、放线菌素D及苯丁酸氮芥(MACb).晚近还有其他一些联合化疗方案;包括顺铂、博莱霉素及长春新硷(PBV),     

Primary treatment with vincristine, dactinomycin, and cyclophosphamide in nondysgerminomatous germ cell tumor of the ovary

Thirty-three patients with malignant nondysgerminomatous germ cell tumors were treated with vincristine/dactinomycin/cyclophosphamide regimen. Thirty-two patients were suitable for analysis. The overall cure rate was 68.7%. This is comparable to the cure rate observed in the cisplatin/vinblastin/bleomycin regimen. The roles of second-look laparotomy in malignant germ cell tumor are discussed.     

Germ cell tumors of the ovary: Is there a role for aggressive cytoreductive surgery for nondysgerminomatous tumors?

Abstract. Bafna UD, Umadevi K, Kumaran C, Nagarathna DS, Shashikala P, Tanseem R. Germ cell tumors of the ovary: Is there a role for aggressive cytoreductive surgery for nondysgerminomatous tumors?
Thirty-three patients with germ cell tumor of the ovary were seen at Kidwai Memorial Institute of Oncology (KMIO), Bangalore, between 1996 and 1999. Twelve patients had endodermal sinus tumor (EST), 11 dysgerminoma, seven mixed germ cell tumor, and three immature teratoma. Thirteen patients had bulky residual disease of>10 cm after the primary surgery. All but one patient received a combination of bleomycin, etoposide, and cisplatin (BEP) either as neoadjuvant (NACT, 3 cases) or as adjuvant therapy (28 cases). In the present study, all 11 patients with dysgerminoma achieved sustained complete remission (CR), irrespective of the size of residual disease at the time of chemotherapy. Four out of six cases (66.6%) with bulky nondysgerminomatous tumor achieved CR, which was sustained in three cases and one recurred. Fifteen of the remaining 16 (93.7%) nonbulky, nondysgerminomatous tumors achieved CR, which was sustained in 14 cases and recurred in one. This study indicates that there may be a role for aggressive cytoreductive surgery, either primary/interval or at the time of second-look laparotomy, in selected patients with nondysgerminomatous germ cell tumor of the ovary.     

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。     

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.     

Nondysgerminomatous tumors of the ovary treated with cisplatin, vinblastine, and bleomycin: long-term results.

Twenty-four consecutive patients with nondysgerminomatous germ cell tumor of the ovary were treated after surgery with cisplatin, vinblastine, and bleomycin (PVB regimen). The cycle was repeated every 3 weeks for three to five courses. Fourteen patients had endodermal sinus tumor, and 10 had mixed germ cell tumors. Stage of disease (FIGO, 1986) was as follows: stage I, 6; stage IIc-IV, 17; and recurrence, 1 patient. All patients were monitored by alpha-fetoprotein and human chorionic gonadotropin. Only 1 patient had received previous chemotherapy. All 5 patients without residual disease and with negative marker levels in which PVB was used as adjuvant treatment were free of disease for a median duration of 59 months from the start of PVB. Of the 19 patients with measurable disease (evident disease or positive marker levels), complete remission was obtained in 16 (84%), but 5 of these relapsed. Therefore, treatment with PVB failed in 8 out of 19 patients (42%) with measurable disease. Toxicity was evident, but no patient died of it. Menses were regular in 11 patients whose initial surgery was conservative. PVB regimen is an effective but not a satisfactory treatment. The considerable failure rate of PVB treatment suggests the investigation of other regimens.     

The role of second look laparotomy and tumor markers in the follow-up of endodermal sinus tumor of the ovary. A case report and review of the literature.

Endodermal sinus tumor (EST) of the ovary is extremely rare and little information exists about therapy and the role of second-look laparotomy in the management of this entity. A case of EST of the ovary in a 21 year old woman is reported. She received conservative surgery and six courses of combination therapy consisting of Vincristine, Actinomycin D and Cyclophosphamide before second-look laparotomy. Due to progression of the disease second-line polychemotherapy with Vinblastine, Bleomycin and Cisplatin was administered. This new regimen reduced the alpha-fetoprotein to normal levels although the patient was not free of disease on second-look laparotomy. Precise guidelines for the management of this disease, especially in advanced stages, are still lacking.     

Outcome and reproductive function after cumulative high-dose combination chemotherapy with bleomycin, etoposide and cisplatin (BEP) for patients with ovarian endodermal sinus tumor

ObjectiveThe aim of this study was to investigate the outcome and reproductive function of patients with ovarian endodermal sinus tumor (EST) after cumulative high-dose combination chemotherapy with bleomycin, etoposide and cisplatin (BEP).MethodsBetween 1995 and 2006, 1034 patients with the diagnosis of ovarian cancer were treated at a single institution. Among these patients, 51 had a confirmed diagnosis of malignant ovarian germ cell tumor (MOGCT) including 20 cases of EST. We retrospectively reviewed those patients with EST, who received BEP as adjuvant chemotherapy. The doses were 15 mg/day of bleomycin on days 1 to 3, 100 mg/m²/day IV of etoposide on days 1 to 3 and 20 mg/m²/day of cisplatin on days 1 to 5. The median number of total cycles was six (range between three and nine).ResultsThe median age of the patients with EST was 18 years (range 5 to 36). All except two were nulliparous. The overall survival rate was 90% at a median follow-up of 70 months. Two patients (10%) had disease recurrence in the pelvis. Of the 15 patients who were treated with fertility-sparing surgery, all had regular menstruation following the completion of adjuvant chemotherapy, and two of these patients had pregnancies with live birth deliveries and no complications.ConclusionIn patients with EST, the cumulative high-dose BEP regimen resulted in excellent overall survival and did not seem to impair ovarian function.     

Seven tumor markers in benign and malignant germ cell tumors of the ovary

Seven tumor markers were analyzed clinically in 135 patients with germ cell tumors of the ovary who were treated in Tokai Ovarian Tumor Study Group, an association comprising Nagoya University and its affiliated hospitals, between January 1979 and September 1990. Positive rate of AFP was 100% (36/36) in yolk sac tumor, 61.9% (13/21) in immature teratoma, and 11.8% (2/17) in dysgerminoma, but there were no positive cases of mature cystic teratoma with malignant transformation (0/7) and mature cystic teratoma (0/31). Positive rate of CA125 was over 50% in all tumor types except mature cystic teratoma, which showed a positive rate of 23.7%. CA125 was useful for the screening of malignant germ cell tumors. CA19-9 showed a high positive rate in teratomatous tumors, which were immature teratoma, mature cystic teratoma with malignant transformation, and mature cystic teratoma. Dysgerminoma and yolk sac tumor, especially dysgerminoma, had a high positive rate of LDH. TPA and CEA were not considered useful tumor markers for germ cell tumors of the ovary.     

Malignant germ cell tumors of the ovary. Pregnancy considerations

OBJECTIVE: To study the pregnancy association and malignant germ cell tumors of the ovary with regard to its effects on tumor prognosis. STUDY DESIGN:: Seventy-five patients with malignant germ cell tumors of the ovary treated at the King Faisal Specialist Hospital-Research Center (KFSH-RC) Riyadh, Kingdom of Saudi Arabia between January 1976 and December 1992, were reviewed. Data was retrieved from the medical records and the database of ovarian tumor pathology. Patients with tumor/pregnancy association were identified and correlation with obstetrical outcome and tumor prognosis analyzed. Patients who conceived after treatment were identified and their reproductive outcome described. RESULTS: Malignant germ cell tumor was associated with pregnancy in a group of ten patients. Possible tumor effects upon pregnancy in this group included operative delivery by caesarean section (n=3), mid-trimester termination (n=2), spontaneous abortion (n=1). Four patients had normal vaginal birth with no apparent tumor effects upon pregnancy. Pregnancy did not seem to influence the tumor prognosis of pure dysgerminoma (n=6), however, two patients with non-dysgerminomatous germ cell tumor (one endodermal sinus tumor and one immature teratoma) died of rapidly progressive disease during the second trimester. Two patients with advanced (stage IIIC) disease concurrent with pregnancy (one pure dysgerminoma and one mixed germ cell tumor), had normal fetal outcomes and achieved long-term survival. Amongst the 22 patients who planned to conceive after conservative surgery, with or without post-operative adjuvant chemotherapy, 12 conceived (12/22) and achieved a total of 20 pregnancies. Their outcomes included normal births (n=18) including one set of twins and hydatidiform moles (n=2). CONCLUSIONS: Our findings suggest that, (1) The association of pure dysgerminoma and pregnancy did not adversely affect the tumor prognosis or fetal outcome. However, the question remains as to whether pregnancy worsened the prognosis of non-dysgerminomatous germ cell tumors. (2) Recent platinum-based regimens of multiagent chemotherapy for germ cell tumors did not seem to affect fertility potential.     

Ovarian nondysgerminomatous germ cell tumors in childhood and adolescence in Israel: Comparison of survival between two periods

Menczer J, Geva D, Barchana M. Ovarian nondysgerminomatous germ cell tumors in childhood and adolescence in Israel: Comparison of survival between two periods. Int J Gynecol Cancer 1998; 8 : 124–127.
During a 25 year period, 40 patients ≤19 years old with ovarian nondysgerminomatous germ cell malignancies were diagnosed throughout Israel—15 during the early (1970–1979) and 25 during the late (1980–1994) study period. No difference between the periods was found with regard to distribution of tumor type, age and stage at diagnosis, and type of initial operation. The five-year survival of patients diagnosed during the late period was significantly longer than during the early period (79.8% vs 53.3%, respectively; P = 0.05). This improved survival can most probably be attributed to the significantly higher percentage of patients who received platin-based combination chemotherapy during the late period. Most of the patients had fertility-sparing surgery and subsequently, among the 22 surviving patients older than 18 years, eight were married at the last date of follow-up, and six of those delivered 11 infants. None of the patients developed leukemia. The rarity of ovarian nondysgerminomatous malignancies should prompt centralization of management for obtaining optimal outcome.