卵巢卵黄囊瘤的治疗及预后

背景与目的：探讨卵巢卵黄囊瘤的治疗方法与预后因素。方法：回顾性分析浙江省肿瘤医院1980年1月-2000年1月收治的卵巢卵黄囊瘤52例的临床病例资料。根据治疗方法将患者分为4组：A组（11例）行不保留生育功能手术加术后以铂类为主联合化疗；B组（10例）行不保留生育功能手术加术后以非铂类的联合化疗；C组（23例）行保留生育功能的分期手术加术后以铂类为主的联合化疗；D组（8例）行保留生育功能的分期手术加术后非铂类的联合化疗。对4组患者的生存率及预后因素进行分析。结果：52例患者5年生存率为69．2％。A组、B组、C组和D组的5年生存率分别为81．8％、40．0％、82．6％和50．0％。术后接受铂类为主化疗患者5年生存率为82．4％（28／34），显著高于非铂类化疗患者44．4％（8／18）（P〈0．05）。A组与B组、C组与D组比较，具有显著性差异（P〈0．05）。但A组与C组、B组与D组比较，无显著性差异（P〉0．05）。多因素分析显示，临床期别、术后残留病灶、术后以铂类为主的联合化疗是影响卵巢卵黄囊瘤患者预后的重要因素。结论：进行准确的手术分期和理想的减瘤术，术后辅以铂类为主的联合化疗，是卵巢卵黄囊瘤理想的治疗模式。保留生育功能手术不影响患者的预后。

Treatment and prognostic factors for the patients with yolk sac tumors of the ovary

Background and purpose:To evaluate the treatment regimens used for patients with yolk sac tumors of the ovary and prognostic factors in our hospital. Methods:Clinical data for the patients with yolk sac tumors of the ovary were analyzed retrospectively. Patients were divided into four groups: patients in A group received nonsparing surgery and platinum-based chemotherapy; in B group received nonsparing surgery and non-platinum-based chemotherapy; in C group received fertility-sparing surgery and platinum-based chemotherapy; in D group received fertility-sparing surgery and non-platinum-based chemotherapy. 5-year survival rate and prognostic factors were analyzed.Results:The overall 5- year survival rate was 69.2 %. The 5- years survival rates were 81.8 %, 40.0 %, 82.6% and 50.0% for A, B, C and D group, respectively. Platinum-based chemotherapy achieved significant survival benefit (82.4% vs. 44.4%, P<0.05). There were significant differences in terms of the 5- years survival rates between A and B, C and D group(P<0.05), but there were no significant differences in the 5- years survival rates between A and C, B and D group(P>0.05). Clinical stage, the size of residual tumor and Platinum-based chemotherapy were the mainly prognostic factors in multianalysis.Conclusions:Fertility-sparing surgery with a postoperative plainum-based chemotherapy should be the ideal modality for the treatment of yolk sac tumors of the ovary. Staging and tumor-reductive surgery were most associated with the prognosis of the patients.