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背景与目的:有效的联合化疗方案应用于卵巢恶性生殖细胞肿瘤的治疗后,肿瘤的复发率大大降低。但是仍有10%~40%的患者在初治后复发,这些患者的预后明显不如其他患者。本研究的目的在于探讨影响卵巢恶性生殖细胞肿瘤术后复发的相关因素。方法:回顾性分析我科1990年4月—2004年12月间收治的145例卵巢恶性生殖细胞肿瘤的临床病理特点,运用Kaplan-Meirer法计算术后复发率,应用Log-rank法和COX比例风险模型对可能影响卵巢恶性生殖细胞肿瘤术后复发的因素进行单因素和多因素分析。结果:全组患者术后1年、3年、5年的复发率为21%、36%、43%。单因素分析显示:非无性细胞瘤、FIGOⅡ~Ⅳ期、肿瘤>15cm、术后残瘤>1cm以及术后未行标准BEP/PVB方案化疗的患者术后复发的危险性较其他患者高(P<0.05),但多因素分析显示肿瘤>15cm并非影响术后复发的独立因素。结论:病理类型、肿瘤分期、术后残瘤大小与术后化疗是影响卵巢恶性生殖细胞肿瘤术后复发的独立因素。治疗应以保留生育功能的手术为主,非无性细胞瘤、FIGOⅡ~Ⅳ期、术后残瘤>1cm等有复发危险因素的患者术后应该及时、足量地应用标准BEP/PVB方案化疗。
BACKGROUND & OBJECTIVE: Effective combination of chemotherapy regimen in the treatment of ovarian malignant germ cell tumors, tumor recurrence rate is greatly reduced. However, there are still 10% to 40% of patients relapse after initial treatment, the prognosis of these patients was significantly worse than other patients. The purpose of this study is to explore the factors that influence the postoperative recurrence of ovarian germ cell tumors. Methods: The clinical and pathological features of 145 ovarian malignant germ cell tumors in our department from April 1990 to December 2004 were retrospectively analyzed. The postoperative recurrence rate was calculated by Kaplan-Meirer method. Log-rank method and COX ratio Risk model of ovarian malignant germ cell tumors may affect the recurrence of the factors by univariate and multivariate analysis. Results: The recurrence rates of the patients in one year, three years and five years after operation were 21%, 36% and 43% respectively. Univariate analysis showed that the recurrence risk of non-dysgerminoma, FIGO Ⅱ ~ Ⅳ, tumor> 15cm, postoperative residual tumor> 1cm and postoperative chemotherapy without standard BEP / PVB regimen were higher than those of other patients (P <0.05), but multivariate analysis showed that tumor> 15cm was not an independent factor that affected postoperative recurrence. Conclusion: The pathological type, tumor stage, postoperative residual tumor size and postoperative chemotherapy are the independent factors affecting the recurrence of ovarian malignant germ cell tumors. The treatment should be based on the operation of preserving fertility. Patients with non-dysgerminoma, FIGOⅡ ~ Ⅳ, postoperative residual tumor> 1cm and other risk factors for recurrence should be treated with standard BEP / PVB regimen timely and adequately.