| BackgroundMature cystic teratoma of the Ovary(MCTO)is the most common benign ovarian tumor in women of reproductive age,of which about 0.17%-2%can be malignant.Current studies show that squamous cell carcinoma is the main type of MCTO malignancy,accounting for about 80%,while other types of malignancy(adenocarcinoma,carcinoid,melanoma,sarcoma,etc.)are relatively rare.Mature differentiated MCTO consists of mature tissues from three germ cell layers,each of which can occur malignant transformation.The prognosis of patients in early stage was good after complete resection of mature cystic teratoma malignant,while the prognosis of patients in advanced stage was poor due to adverse behaviors such as spreading of surrounding tissues and greater omentum,lymph node metastasis caused by invasive tumor growth.As such patients are relatively rare,literature reports are mainly individual cases,and at present there is no unified treatment scheme.ObjectiveThe clinical characteristics,pathological characteristics,treatment methods and prognosis of patients with MCTO malignant were retrospectively analyzed,and the clinical characteristics and prognostic factors of patients were studied,so as to guide the treatment and postoperative adjuvant treatment of patients with MCTO malignant.MethodsThe clinical medical records and follow-up data of 23 patients from Qilu Hospital of Shandong University with MCTO malignant from January 2005 to June 2021 were collected,and the clinical and pathological features were retrospectively studied.Including age,clinical manifestations,imaging examinations,tumor markers,surgical methods,rapid intraoperative pathological diagnosis,postoperative adjuvant therapy,recurrence and survival;at the same time,PubMed database was searched to collect relevant published literature data from January 2005 to December 2021,and Individual patient data(IPD)in relevant literature was collected,and the two data were summarized and statistically analyzed.To explore the clinicopathological characteristics,surgical methods and prognosis,and analyze the related risk factors influencing the prognosis with MCTO malignancy.SPSS 25.0 software was brought to statistical analysis.The measurement data of skewness distribution are represented by median and range.The number and percentage of counting data;χ2 test and Fisher’s exact probability method were used to compare the classification variables of different sample sizes.Mann-Whitney U test was used for the two groups of independent non-normal distribution data.Kaplan-Meier method was brought to the survival curve and single factor analysis,and log-rank method was brought to test the significance of difference.Hazard ratio(HR)and 95%Confidence interval(CI)were calculated by univariate and multivariate COX proportional risk regression models.P<0.05 was considered statistically significant.Results1.Amount to 4060 cases of MCTO patients were hospitalized in Qilu Hospital of Shandong University from January 2005 to June 2021.Among them,23 cases were MCTO malignant transformation,with a malignant transformation rate of 0.567%,mainly squamous cell cacinoma,accounting for 60.87%.A total of 123 cases of MCTO malignant transformation including 8 case series reports and 89 case reports were included in PubMed database from January 2005 to December 2021.146 cases in this study were included for analysis.2.The median age of MCTO malignant transformation patients included in our hospital was 53 years old,ranging from 26 to 75 years old.The mean age of 146 patients with MCTO malignancy was 48.31 years old,ranging from 19 to 80 years old.Age was not a prognostic factor for early(stage I,Log-rank P=0.074)and late(stage Ⅱ-Ⅳ,Log-rank P=0.705).3.The mean tumor diameter of patients with MCTO malignancy was 13.70cm,ranged from 2.5cm to 35cm.There was no clear difference between early stage(Log-rank P=0.786)and intermediate and advanced stage(Log-rank P=0.240)in tumor size.4.Most of the patients with MCTO malignant transformation were treated for abdominal pain(45.21%),abdominal distension(21.23%)and conscious abdominal mass(13.70%),and 17.12%had no obvious conscious symptoms during routine physical examination.5.The proportion of abnormal increase of preoperative tumor marker CA125 in patients with intermediate and advanced stage(Ⅱ-Ⅳ,78.13%)was significantly exceeded in that in patients with early stage(I,42.86%,P=0.001),but which was no obvious difference in the increased level of CA125 between them.Preoperative serum Squamous cell cacinoma antigen(SCC-Ag)levels in intermediate and advanced(19.3 ng/ml)patients were more significant than those in early patients(5.4ng/ml,P=0.044),but no clearly difference in the proportion of patients between the two groups.And it was no obvious significance in HR for CA125 and SCC-Ag prognostic factors analysis.6.46.51%(20/43)of the patients were found to be completely consistent with the routine postoperative pathology by rapid pathological examination,27.91%(12/43)of the patients were found to be unclassified teratoma malignancy suspicious or unable to exclude malignancy.20.93%(9/43)patients had rapid pathological consideration of MCTO.7.There were no obvious differences in recurrence rate(P=0.488),mortality(P=1.00)and survival rate(log-rank P=0.335)between patients with age<45 years and surgical pathological stage IA or IC with or without fertility preservation surgery.8.Stage Ⅰ patients accounted for 66.44%,the 5-year survival rate was 93.0%,while stage Ⅱ5-year survival rate was 72.9%,Stage Ⅲ was 28.5%,while stage Ⅳ 7.7%.Stage Ⅰ patients were classified as early stage,and stage Ⅱ-Ⅳ patients as intermediate and advanced stage.The median survival time of stage Ⅱ-Ⅳ patients was 12 months,at the same time the mortality risk of stage Ⅱ-Ⅳ patients was 13.909 times prep above that of early patients(P<0.001).Clinical stage was an independent factor affecting the prognosis of patients.Pathological type and histological grade did not affect prognosis.9.stage IC was associated with poor outcome in early patients(P<0.001).Pathological type of tumor(Log-rank P=0.215),hysterectomy(Log-rank P=0.098),greater omentum resection(Log-rank P=0.716),lymph node resection(Log-rank P=0.716)had no significant correlation with the prognosis of early patients.10.Hysterectomy(P=0.013),lymph node resection(P=0.049)and postoperative adjuvant chemotherapy(P=0.014)were closely related to the prognosis of intermediate and advanced patients.There was no significant correlation between pathological type(Log-rank P=0.113)and greater omentum resection(Log-rank P=0.062).For patients with intermediate and advanced squamous cell carcinoma or adenocarcinoma,platinum(P=0.129)and paclitaxel(P=0.658)chemotherapy drugs cannot significantly improve the prognosis.Conclusion1.The clinical manifestations of malignant transformation from MCTO are mostly non-specific,and most of them are stage Ⅰ and have a good prognosis.2.Preoperative serum SCC-Ag level is higher in patients with intermediate and advanced MCTO malignancy than in patients with early,and the proportion of increased CA125 is higher in patients with intermediate and advanced.3.Rapid freezing pathological diagnosis is helpful for intraoperative diagnosis,but missed diagnosis rate still exists.4.In early stage IA and IC patients with fertility need,fertility preservation surgery is feasible.Comprehensive staging is still recommended for intermediate and advanced patients,and adjuvant chemotherapy is recommended after surgery.5.Clinical stage Is an independent factor affecting prognosis of patients. |
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