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目的探讨全面分期手术对卵巢恶性生殖细胞肿瘤(MOGCT)初治患者预后的影响。方法收集北京协和医院1980年6月—2003年6月收治的127例MOGCT患者的临床病理资料,分析其初治时的手术方式与预后的相关性。结果127例患者中,行全面分期手术者45例(35.4%),未行全面分期手术者82例(64.6%);术后残余瘤直径<2 cm(即手术彻底)者71例(55.9%),直径≥2 cm(即手术不彻底)者11例(8.7%),不详者45例(35.4%);采用顺铂+长春新碱+博莱霉素(PVB)或博莱霉素+足叶乙甙+顺铂(BEP)方案化疗者75例(59.1%),长春新碱+阿霉素+环磷酰胺(VAC)方案化疗者18例(14.2%),未化疗或行其他方案化疗者34例(26.8%)。随访期(2~254个月)内,行全面分期手术者复发率为16%(7/45),未行全面分期手术者复发率为61%(50/82),两者比较,差异有统计学意义(P<0.05)。多因素分析结果显示,全面分期手术不影响无瘤生存时间(P=0.061),化疗方案、手术彻底性是明显影响无瘤生存时间的因素(P<0.05)。行全面分期手术者随访2~158个月,死亡率为7%(3/45),未行全面分期手术者随访4~254个月,死亡率为15%(12/82),两者比较,差异无统计学意义(P>0.05)。全面分期手术不影响长期生存时间(P>0.05),化疗方案、手术彻底性明显影响长期生存时间(P<0.05)。结论手术彻底和规范化疗明显影响MOGCT初治患者的预后,而是否实施全面分期手术对初治患者预后无明显影响。
Objective To investigate the effect of total staging on the prognosis of patients with ovarian germ-cell germ cell tumors (MOGCT). Methods The clinical and pathological data of 127 patients with MOGCT admitted from June 1980 to June 2003 in Peking Union Medical College Hospital were collected. The correlation between the operation mode and prognosis was analyzed. Results Of the 127 patients, 45 (35.4%) were underwent total staging and 82 (64.6%) were not underwent total staging. 71 (55.9%) patients had residual tumor of less than 2 cm ), 11 cases (8.7%) with diameter≥2 cm (ie, incomplete operation), 45 cases (35.4%) with unknown diameter; the patients with cisplatin + vincristine + bleomycin (PVB) Etoposide + cisplatin (BEP) chemotherapy in 75 patients (59.1%), vincristine + doxorubicin + cyclophosphamide (VAC) regimen chemotherapy in 18 patients (14.2%), no chemotherapy or other options Chemotherapy in 34 cases (26.8%). During the follow-up period (2 ~ 254 months), the recurrence rate was 16% (7/45) in patients undergoing total staging and 61% (50/82) in those who underwent complete staging. There was significant difference between the two groups Statistical significance (P <0.05). Multivariate analysis showed that total staging did not affect tumor-free survival (P = 0.061). Chemotherapy regimen and thoroughness of surgery were the factors significantly influencing tumor-free survival time (P <0.05). The total staging operation was followed up for 2 to 158 months with a mortality rate of 7% (3/45). Patients who had not undergone full staging were followed up for 4 to 254 months with a mortality rate of 15% (12/82) , The difference was not statistically significant (P> 0.05). Total staging did not affect the long-term survival time (P> 0.05). The chemotherapy regimen and the thoroughness of surgery significantly affected the long-term survival time (P <0.05). Conclusion Thorough and standardized chemotherapy can significantly affect the prognosis of patients with newly diagnosed MOGCT. However, no significant effect on the prognosis of patients with newly diagnosed MOGCT has been found after the operation of total staging.