Risk Factors for Prognosis of Fertility-sparing Surgery on Malignant Ovarian Germ Cell Tumors Patients
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摘要: 目的 探讨影响卵巢恶性生殖细胞肿瘤保留生育功能手术患者预后的相关因素。方法 回顾性分析1986年1月1日至2010年12月31日广西医科大学附属肿瘤医院妇瘤科收治的卵巢恶性生殖细胞肿瘤（malignant ovarian germ cell tumors，MOGCT）保留生育术患者的临床资料及随访结果，以Kaplan-Meier法绘制生存曲线，并比较单因素中不同因素影响生存时间的差异，其差异性经Log rank检验，并用Cox模型进行多因素回归分析，用Logistic回归分析不同因素对生育能力的影响。结果 60例患者中位年龄20（9~34）岁，中位随访时间41.5（2~237）月，复发4例，死亡9例。31例患者怀孕并生育健康婴儿。单因素分析显示病理类型、术后残留病灶大小、化疗疗程、对侧卵巢活检、淋巴结切除及大网膜切除等与预后相关，而对患者生育无明显影响。多因素分析显示仅有术后残留病灶大小是影响患者无瘤生存及长期生存的独立因素。结论 术后残留病灶大小可影响MOGCT患者的预后，全面分期手术对预后无明显改善。MOGCT保留生育手术后生存率较高，生育能力亦得到较好保存。
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关键词:
- 卵巢恶性生殖细胞肿瘤 /
- 保留生育手术 /
- Cox模型 /
- 预后
Abstract: Objective To evaluate the risk factors for the prognosis of malignant ovarian germ cell tumors (MOGCT) patients after receiving fertility-sparing surgery. Methods We retrospectively analyzed the clinical data and follow-up results of MOGCT in the Affiliated Cancer Hospital of Guangxi Medical University from Jan. 1st, 1986 to Dec. 31st, 2010. Kaplan-Meier methods were used to draw survival curves and Log rank test was used to analyze the factors for survival time. Multivariate analysis including Cox regression analysis and logistic regression analysis were performed to analyze the influence of different factors on patients' fertility. Results The median age of 60 MOGCT patients was 20(9-34) years old. The median follow-up time was 41.5(2-237) months, with 4 patients replased and 9 patients died. Thirty-one patients were pregnant and gave birth to healthy babies. Univariate analysis showed that pathological type, residual size, chemotherapy, contralateral ovarian biopsy, lymph resection and omentum majus resection were related to the prognosis of patients, but inconspicuously affected on fertility. Multivariate analysis showed that only the postoperative residual tumor size influenced patients' progression-free survival (PFS) and overall survival (OS). Conclusion Postoperative residual tumor size could affect the PFS and OS of MOGCT patients. Comprehensive staging operation had inconspicuous improvement on the prognosis. MOGCT patients achieve an excellent survival and fertility after conservative surgery. -
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