Possibility of women treated with fertility-sparing surgery for non-epithelial ovarian tumors to safely and successfully become pregnant-a Chinese retrospective cohort study among 148 cases / 医学前沿

This study was performed to evaluate the oncological and reproductive outcomes of childbearing-age women treated with fertility-sparing surgery (FSS) for non-epithelial ovarian tumors in China. One hundred and forty eight non-epithelial ovarian tumor women treated with FSS between January 1, 2000 and August 31, 2015 from two medical centers in China were identified. Progression-free survival (PFS) was 88.5%, whereas overall survival (OS) was 93.9%. Univariate analysis suggested that delivery after treatment is related to PFS (P = 0.023), whereas histology significantly influenced OS. Cox regression analysis suggested that only histology was associated with PFS and OS (P < 0.05). Among the 129 women who completed adjuvant chemotherapy (ACT), none developed amenorrhea. Among the 44 women who desired pregnancy, 35 (79.5%) successfully had 51 gestations including 35 live births without birth defects. Non-epithelial ovarian tumors can achieve fulfilling prognosis after FSS and chemotherapy. Histology might be the only independent prognostic factor for PFS and OS. FSS followed by ACT appeared to have little or no effect on fertility. Meanwhile, postoperative pregnancy did not increase the PFS or OS. Use of gonadotropin-releasing hormone agonist was not beneficial for fertility.

Malignant extra-cranial germ cell tumors in children and adolescents: Results following the guidelines of SFOP/SFCE 95 Protocol

Between September 1995 and December 2010, 99 new consecutive assessable patients with extra-cranial MGCT were treated according to SFOP/SFCE TGM95 Protocol. A "watch and wait" strategy for completely resected stage I-II was observed in cases with preoperative high tumor markers levels. Metastatic disease or alpha fetoprotein levels > 15 000 ng/ml cases were treated by VIP chemotherapy (etoposide, ifosfamide and CDDP) 4-6-courses. All other cases were treated by VBP (vinblastine, bleomycin, and CDDP) 3-5 courses. Median age for the whole group was 11.1 (r: 0-17) years. Males: 49, females: 50. Stage I: 19 patients, stage II: 16, stage III: 31 and stage IV: 3. Gonadal disease occurred in 77 cases. Of 21 completely resected stage I-II patients with MGCT who did not receive chemotherapy after surgery, 6 presented disease progression and were successfully treated by chemotherapy and remained disease-free. There were no significant differences in outcome according to age, gender, initial site, staging, and histological variant or high levels of alpha-fetoprotein. Initial non-responsiveness to VIP chemotherapy was the only significant unfavorable prognostic feature. With a median follow-up of 64 (r: 5-204) months, at 10 years EFS and OS estimates for the whole group were 0.82 (SE = 0.05) and 0.90 (SE = 0.03) respectively. Therapy results of MGCT treated with the SFOP/SFCE 95 strategy were excellent. Initial non-response to front line chemotherapy was the only significant adverse prognostic feature. The "watch and wait" strategy for completely resected disease with initial positive markers proved to be safe with optimal outcome.

Entre septiembre de 1995 y diciembre 2010 se registraron 99 nuevos pacientes evaluables consecutivos con tumores germinales malignos (TGM) extra-cerebrales. Los pacientes fueron tratados prospectivamente según los lineamientos del Protocolo SFOP/SFCE TGM95. Se siguió una estrategia de watch and wait para la enfermedad estadio I-II completamente resecada. La enfermedad con metástasis y los casos con niveles de alfa fetoproteína > 15 000 ng/ml fueron tratados con etopósido, ifosfamida y CDDP, 4-6 cursos. El resto fue tratado con vinblastina, bleomicina y CDDP, 3-5 ciclos. La mediana de edad fue de 11.1 (r: 0-17) años. Varones: 49, niñas: 50. Estadio I: 19 casos; II: 16; III: 31y IV: 33. De 21 enfermos con estadios tumorales I y II con resección completa inicial que no tuvieron tratamiento adyuvante, seis progresaron, todos fueron exitosamente tratados con quimioterapia y permanecieron libres de enfermedad. No hubo diferencias significativas en los resultados de supervivencia según edad, género, sitio inicial, estadificación, variante histológica o niveles elevados de alfa-fetoproteína. La resistencia primaria a la quimioterapia VIP fue el único factor pronóstico desfavorable significativo. Con una mediana de seguimiento de 64 (r: 5-204) meses, a 10 años las probabilidades de supervivencia libre de eventos y supervivencia global para todo el grupo fueron respectivamente de 0.82 (EE = 0.05) y 0.90 (EE = 0.03). Los resultados con la estrategia SFOP/SFCE 95 fueron excelentes. La ausencia de respuesta a la quimioterapia de primera línea fue el único factor pronóstico adverso significativo. La estrategia de watch and wait probó ser segura y eficaz.

Effect of chemotherapy on ovarian function in young patients with malignant germ cell tumors of the ovary after conservative surgery / 中国综合临床

Objective To investigate the effect of chemotherapy on ovarian function in young patients with malignant germ cell tumors of the ovary after conservative surgery.Methods 15 patients (11～29 years old) with ovarian malignant germ cell tumors were treated by ovarectomy and the following chemotherapy.Their menstruation and serum follicle-stimulating hormone(FSH),luteinizing hormone(LH),estradiol(E2) levels and basal antral follicle(F0) numbers were observed from the duration of chemotherapy to one year after chemotherapy.The serum levels of FSH,LH,E2 and basal antral follicle numbers between the chemotherapy-related amenorrhea(CRA) patients and the patients with benign tumors of ovary who underwent unilateral adnexa removed at the same period(control group,n=10) were compared.Results Oligomenstruation occurred in 13 of 15 cases undergoing chemotherapy after conservative surgery(86.7%),in whom CRA occurred in 10 cases(66.7%) at the duration of 4-6 cycle chemotherapy appearing significantly rising serum level of FSH,LH and declining serum E2 level and F0 numbers.There was a significantly positive correlation between the frequency of amenorrhea and the duration of chemotherapy(r=1.000,P=0.01).Generally menstruation resumed around 2～3 months after chemotherapy.Ahhough the serum levels of sexual hormone seemed to be normal at half a year after chemotherapy in CRA patients,the serum FSH(8.30±1.46 mU/ml) and E2(80.50±7.86 ng/L) level were significantly increased as compared with that of the control group and the reverse was found in Fo numbers(3.80±1.04) (t Fo,FsH,E2=7.660,5.277,7.225;P F0,FSH,E2<0.001,<0.001,<0.001).One year after chemotherapy,serum hormone level and the ovary reserve function of the CRA patient came to be normal[FSH=(5.59±0.52)mU/ml,LH=(5.25±0.84)mU/ml,E2=(56.50±5.13)ng/L,Fo=(6.50±1.08)] and that of control group [FSH=(5.43±0.35)mU/ml,LH=(5.17±0.48)mU/ml,E2=(58.10±3.73)ng/L,F0=(6.60±0.97)](t=1.177,0.694,0.505,0.740;P>0.05,>0.05,>0.05,P>0.05).Conclusions Ovarian function impairment may occur in young patients in adolescence and sexual maturity period with ovarian malignant germ cell tumors who were treated by conservative surgery followed by chemotherapy.Although the CRA is reversible,the recovery of menstruation does not meail the recovery of ovarian funetion.because the ovarian impairment may continue to a duration of half a year after chemotherapy.The drug which can safeguard ovariall function should be considered during chemotherapy.

Clinicopathological Analysis of Malignant Germ Cell Tumors of Ovary / 대한부인종양콜포스코피학회잡지

Malignant germ cell tumors occur in children and young women in reproductive age, of all the germ cell malignancies, only pure dysgerminomas had a high cure rate prior to 1970. This was due to the exquisite radiosensitivity of these tumors. Multiple-agent chemotherapy has dramatically improved the pmgnosis of patients with malignant ovarian germ cell tumors. Clinicopathological analysis was performed on 21 cases of malignant germ cell tumors of the ovary, 9 cases at the department of Obstetrics & Gynecology, Kyung-pook National University Hospital, 4 cases, at the department of Obstetrics and Gynecology, Dong-guk University Kyungju Hospital and 8 cases, at the department of Obstetrics and Gynecology, Dae-gu Fatima Hospital during the period 10 years from July. 19S8 to June. 1997 The results were summarized as follows: 1. The mean age of the patients was 21.8 years old, ranging from 10 to 61 years old. 2. Main initial symptoms were abdominal distension(33.3%), abdominal mass palpation(33.3%), abdominal pain(28.6%), amenorrhea(4.8%) in order. 3. Histologically, the tumors were classified as immature teratoma(57.1%), dysgerminoma(19%), mixed germ cell tumor(9.5%), endodermal sinus tumor(9.5%), embryonal cell carcinoma(4.8%). 4, According to FIGO classification Stage I was the most prevalent(57.1%) at the time of diagnosis while Stage III was forward in 48.6%, Stage II in 9.5%, and no Stage IV, 5. The 5-year survival rate was 80.4% and three patients have died of malignancy and the other 18 patients live without disease from 11 to 102 months, with a median follow-up of 34.2 months. 6. Prognostic factors of malignant germ cell tumors in this study were the clinical stage, the presence of ascites and the residual tumor mass.