[Prognostic factors analysis in patients with ovarian malignant germ cell tumor treated with fertility-preserving surgery]

Abstract

Objective: To analyse the clinicopathologic factors affecting prognosis and fertility of patients with malignant ovarian germ cell tumor (MOGCT).

Methods: The medical records and follow up data of 106 patients with MOGCT treated at Affiliated Tumor Hospital of Guangxi Medical University between January 1986 and December 2010.Kaplan-Meier method was used to analyse survival curves. The different prognoses between different clinicopathologic factor was evaluated by univariate analysis and log-rank test. The multivariate analysis was performed by the Cox proportional hazard regression method. Logistic regression analysis was used to evaluate the influence of different factors on the prognoses and fertility.

Results: The median age at primary treatment was 22 years old (range: 9 - 61 years old), 59 patients received fertility-preserving surgery, 45 patients received radical surgery, only 2 cases performed biopsy; 94 patients received postoperative adjuvant chemotherapy. Median follow-up time was 56.5 months (range: 2 - 309 months), there were 11 cases recurrences, 23 cases died from cancer. Of 47 patients live without tumor, 45 patients had normal menstrual. Of the 39 patients desiring pregnancy, 31 cases got 33 successful pregnancies, resulting in 33 live births. There is no statistically significant difference (P > 0.05) in progression free survival (PFS; 67.6% versus 63.3%) and overall survival (OS; 70.0% versus 64.1%) and mortality [15% (9/59) versus 31% (14/45)] between fertility-preserving surgery patients and radical surgery patients. The univariate analysis showed that the pathological types, postoperative residual tumor size, lymph nodes and omental resection were associated with OS (P < 0.1), and postoperative residual tumor size, chemotherapy cycles, lymph nodes and omental resection were associated with PFS (P < 0.1). The multivariate analysis showed only the postoperative residual tumor size was independent prognostic factor of OS (P = 0.039), and postoperative residual tumor size, chemotherapy cycles, lymph nodes resection were independent prognostic factors of PFS (P < 0.05). There is no statistically significant difference in OS, PFS and fertility between fertility-preserving surgery patients treated with or without a comprehensive staging surgery (P > 0.05).

Conclusions: MOGCT can achieve a good prognosis after surgery combined chemotherapy. Postoperative residual tumor size is independent prognostic factor of PFS and OS. Comprehensive staging surgery could not improve prognosis. Fertility-preserving surgery plus adjuvant chemotherapy appeared to have little or no effect on prognosis and fertility.