Journal of Shandong University (Health Sciences) ›› 2018, Vol. 56 ›› Issue (5): 35-40.doi: 10.6040/j.issn.1671-7554.0.2018.233

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Preserve fertility in recurrent and uncontrolled malignant ovarian germ cell tumors

WANG Jinhui1, YANG Jiaxin1, YUAN Zhen1, CAO Dongyan1, SHEN Keng1, HUANG Huifang1, WU Ming1, PAN Lingya1, GUO Lina2   

  1. 1. Department of Obstetrics and Gynaecology;
    2. Department of Pathology, Peking Union Medical College Hospital, Chinese Academy of Medical Science &
    Peking Union Medical College, Beijing 100730, China
  • Received:2018-02-22 Published:2022-09-27

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Abstract: Objective To explore the clinical characteristics, salvage therapy and prognosis of recurrent and uncontrolled malignant ovarian germ cell tumor(MOGCT)and to evaluate the possibility of secondary fertility-sparing surgery. Methods The clinical data of 41 recurrent and uncontrolled MOGCT cases treated during Jan. 1st, 2000 and Mar. 31st, 2017 were retrospectively analyzed. Results There were 18 recurrent and 23 uncontrolled cases. The patients age ranged from 6 to 37 years. FIGO stage: stage I in 25 cases, stage II in 1 case, stage III in 14 cases, and stage IV in 1 case. There were 18 cases of immature teratoma, 14 cases of yolk sac tumor, 1 case of dysgerminoma and 8 cases of mixed germ cell tumor. Secondary fertility-sparing cytoreductive surgery was performed in 31 cases, and secondary cytoreductive surgery without fertility-sparing was performed in 8 cases. During the median follow-up of 30.3 months after recurrence, 2 cases were loss to follow-up, 13 cases(33.3%)had a second relapse, and 10 patients(25.6%)died. The 5-year survival rate after recurrence was 68.7%, and the 5-year progress-free survival rate after recurrence 山 东 大 学 学 报 (医 学 版)56卷5期 -王瑾晖,等.复发和未控卵巢恶性生殖细胞肿瘤保留生育功能的治疗 \=-was 71.5%. FIGO stage and patients satisfaction with cytoreductive surgery were the independent prognostic factors(P<0.05). Conclusion The standardized primary therapy should be emphasized in the treatment of MOGCT. For recurrent and uncontrolled MOGCT, optimal cytoreductive surgery and adjuvant standardized chemotherapy have significant impacts on the prognosis of patients. For young nulliparous patients, secondary fertility-sparing salvage therapy can be taken into consideration.

Key words: Malignant ovarian germ cell tumor, Recurrence, Uncontrolled tumor, Chemoherapy, Salvage surgery

CLC Number: 

  • R737.31
[1] Brown J, Friedlander M, Backes FJ, et al. Gynecologic cancer intergroup(GCIG)consensus review for ovarian germ cell tumors[J]. Int J Gynecol Cancer, 2014, 24(9 Suppl 3): S48-54.
[2] Mangili G, Sigismondi C, Gadducci A, et al. Outcome and risk factors for recurrence in malignant ovarian germ cell tumors: a MITO-9 retrospective study[J]. Int J Gynecol Cancer, 2011, 21(8): 1414-1421.
[3] Wang HB, Yang JX, Shen K, et al. Treatment of recurrent and persistent malignant ovarian germ cell tumors[J]. J Reprod Med, 2009, 18(S2): 64-68.
[4] Segelov E, Campbell J, Ng M, et al. Cisplatin-based chemotherapy for ovarian germ cell malignancies: the Australian experience[J]. J Clin Oncol, 1994, 12(2): 378-384.
[5] Dimopoulos MA, Papadopoulou M, Andreopoulou E, et al. Favorable outcome of ovarian germ cell malignancies treated with cisplatin or carboplatin-based chemotherapy: a Hellenic Cooperative Oncology Group study[J]. Gynecol Oncol,1998, 70(1): 70-74.
[6] Dimopoulos MA, Papadimitriou C, Hamilos G, et al. Treatment of ovarian germ cell tumors with a 3-day bleomycin, etoposide, and cisplatin regimen: a prospective multicenter study[J]. Gynecol Oncol, 2004, 95(3): 695-700.
[7] Murugaesu N, Schmid P, Dancey G, et al. Malignant ovarian germ cell tumors: identification of novel prognostic markers and longterm outcome after multimodality treatment[J]. J Clin Oncol, 2006, 24(30): 4862-4866.
[8] 中华医学会妇科肿瘤学分会. 妇科恶性肿瘤保留生育功能临床诊治指南[J]. 中华妇产科杂志, 2014, 49(4): 243-248.
[9] Park JY, Kim DY, Suh DS, et al. Outcomes of pediatric and adolescent girls with malignant ovarian germ cell tumors[J]. Gynecol Oncol, 2015, 137(3): 418-422.
[10] Morris M, Gershenson DM, Burke TW, et al. Treatment of fallopian tube carcinoma with cisplatin, doxorubicin, and cyclophosphamide[J]. Obstet Gynecol, 1990, 76(6): 1020-1024.
[11] Williams S, Blessing JA, Liao SY, et al. Adjuvant therapy of ovarian germ cell tumors with cisplatin, etoposide, and bleomycin: a trial of the Gynecologic Oncology Group[J]. J Clin Oncol, 1994, 12(4): 701-706.
[12] Li J, Wu X. Current strategy for the treatment of ovarian germ cell tumors role of extensive surgery[J]. Curr Treat Options in Oncol, 2016, 17(8): 44. doi: 10.1007/s11864-016-0416-2.
[13] Ertas IE, Taskin S, Goklu R, et al. Long-term oncological and reproductive outcomes of fertility-sparing cytoreductive surgery in females aged 25 years and younger with malignant ovarian germ cell tumors[J]. J Obstet Gynaecol Res, 2014, 40(3): 797-805.
[14] Siriwan T, Jitti H, Sumonmal M, et al. Malignant ovarian germ cell tumors: clinico-pathological presentation and survival outcomes[J]. Acta Obstet Gynecol Scand, 2010, 89(2): 182-189.
[15] Reddihalli PV, Subbian A, Umadevi K, et al. Immature teratoma of ovary—outcome following primary and secondary surgery: study of a single institution cohort[J]. Eur J Obstet Gynecol Reprod Biol, 2015, 192: 17-21. doi: 10.1016/j.ejogrb.2015.06.017. Epub 2015 Jun 25.
[16] Munkarah A, Gershenson DM, Levenback C, et al. Salvage surgery for chemorefractory ovarian germ cell tumors[J]. Gynecol Oncol, 1994, 55(2): 217-223.
[17] Li J, Yang W, Wu X. Prognostic factors and role of salvage surgery in chemorefractory ovarian germ cell malignancies: a study in Chinese patients[J]. Gynecol Oncol, 2007, 105(3): 769-775.
[18] Yang ZJ, Liu ZC, Wei RJ, et al. An analysis of prognostic factors in patients with ovarian malignant germ cell tumors who are treated with fertility-preserving surgery[J]. Gynecol Obstet Invest, 2016, 81(1): 1-9.
[19] Alcázar JL, Guerriero S, Pascual Má, et al. Clinical and sonographic features of uncommon primary ovarian malignancies[J]. J Clin Ultrasound, 2012, 40(6): 323-329.
[20] Liu Q,Ding X, Yang JX, et al. Multicenter randomized controlled clinical study for the operative treatment of malignant ovarian germ cell tumors[J]. Chin J Obstet Gynecol, 2013, 48(3): 188-192.
[21] 沈铿. 妇科恶性肿瘤保留生育功能治疗应注意的几个问题[J]. 中华妇产科杂志, 2006, 41(4): 219-221.
[22] 杨佳欣, 向阳. 复发性耐药性卵巢恶性生殖细胞肿瘤的治疗[J]. 中国实用妇科与产科杂志, 2015, 3(31): 201-211. YANG Jiaxin, XIANG Yang. Treatment of recurrent and uncontrolled malignant ovarian germ cell tumors[J]. Chin J Prac Gynecol Obstetr, 2015, 3(31): 201-211.
[23] Rashdan S, Einhorn LH. Salvage therapy for patients with germ cell tumor[J]. J Oncol Pract, 2016, 12(5): 437-443.
[24] Simone CG, Markham MJ, Dizon DS. Chemotherapy in ovarian germ cell tumors: a systematic review[J]. Gynecol Oncol, 2016, 141(3): 602-607.
[25] Reddy Ammakkanavar N, Matei D, Abonour R, et al. High-dose chemotherapy for recurrent ovarian germ cell tumors[J]. J Clin Oncol, 2015, 33(2): 226-227.
[26] De Giorgi U, Richard S, Badoglio M, et al. Salvage high-dose chemotherapy in female patients with relapsed/refractory germ-cell tumors: a retrospective analysis of the European Group for Blood and Marrow Transplantation(EBMT)[J]. Ann Oncol, 2017, 28(8):1910-1916.
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