| BackgroundMature cystic teratoma of the ovary(MCTO)is the most common germ cell tumor during the lifetime of a woman.Its biological behavior is benign,however,about 1%-2%of the mature tissue in MCTO will undergo malignant transformation,including squamous cell carcinoma(SCC),adenocarcinoma,small cell carcinoma,sarcoma and malignant melanoma.80%of the malignant transformation is histologic type of SCC,which is called SCC transformation in MCTO.SCC transformation in MCTO is characterized by coexistence of typical components of MCTO and SCC components.Atypical SCC cells were nested,protruding to the basement membrane and interstitial extension.SCC transformation in MCTO often occurs in postmenopausal women and literatures suggest that its prognosis is poor when compared to other ovarian germ cell tumors.Due to the extremely low incidence,relevant literatures are scattered and there is no acknowledged first-line treatment.ObjectiveWe retrospectively analyzed the clinical features,treatment and prognosis of SCC transformation in MCTO.MethodsThe clinical data of all patients with MCTO treated in a Qilu Hospital,Shandong University from January 2005 to October 2016 were screened.The clinical data,including age,brief history,clinical manifestations,preoperative serum tumor marker level,preoperative imaging examination,tumor size,surgical approach,intraoperative and postoperative pathology,histological grade,surgical-pathological stage,adjuvant therapy,follow-up status and follow-up time of the 6 patients diagnosed with SCC transformation in MCTO were collected.Meanwhile,the PubMed database was retrieved and relevant literatures were reviewed.The individual patient data(IPD)in the literatures were extracted,summarized and analyzed statistically.Statistical analysis was performed using SPSS 21.0 statistical software.We performed chi-square test to compare categorical variables and Mann-Whitney U test to compare two independent non-normal distribution variables.Kaplan-Meier plot was performed to draw survival curves.Univariate and multivariate Cox proportional hazards regression model analysis were performed to calculate hazard ratio(HR)and 95%confidence interval(CI).Results1.From January 2005 to October 2016,a total of 1836 MCTO cases were admitted to Qilu Hospital,Shandong University and 6 cases of them were SCC transformation in MCTO.The incidence of SCC transformation was 0.3%.A total of 429 cases of SCC transformation in MCTO were retrieved from the 36 case series and 63 case reports.2.The age of onset of SCC transformation in MCTO was between 19 and 87 years.The average age of onset was 53.5 years.The HR of patients aged ?45 years was 1.91 compared with patients aged<45years(P<0.01).3.The diameter of SCC transformation in MCTO was 3.5-40.0 cm,with the average diameter of 14.8cm;tumor diameter is not a prognostic factor(P =0.73).4.Abdominal pain and palpable abdominal mass are the most common clinical manifestations of SCC transformation in MCTO patients,which accounted for 47.3%and 26.0%of all cases,respectively.5.There was no significant difference in serum SCC-Ag level between stage I(early stage)and stage ?,?,?(advanced stage)(P =0.09).The level of serum CA125 in patients with advanced stage was higher than that in the early stage(P = 0.04).6.Stage ?,?,? and ? accounted for 50%,18.8%,26.8%and 4.4%of all SCC transformation in MCTO cases,respectively.Surgical-pathological stage was independent prognostic factor(P<0.01).The 5-year survival rate of patients of stage ?,?,? and ? were 85.8%,39.1%,26.2%and 0%;respectively.7.The histological grade 1,2 and 3 accounted for 26.6%,41.4%and 32.0%of all SCC transformation in MCTO cases,respectively.The histological grade was not a prognostic factor(P =0.17).8.Hysterectomy reduced the risk of death in patients with SCC transformation in MCTO by 40%(P<0.01).Omentectomy reduced the risk of death in MCTO patients by 24%(P = 0.04);9.For stage I A or I C young patients with fertility requirements,there were no significant differences in mortality between those who took fertility-preserving surgery and those who underwent radical surgery(P = 1.00).10.Adjuvant chemotherapy reduced the risk of death in patients with SCC transformation in MCTO by 40%(P=0.02).HR in patients treated with platinum-based chemotherapy was 0.43(P =0.02)compared with patients with other regimens.Conclusion1.Serum CA125 level in advanced-stage patients is higher than that in early-stage patients.2.Surgical-pathologic stage was an independent prognostic factor of SCC transformation in MCTO.3.Hysterectomy and omentectomy can improve prognosis of SCC transformation in MCTO.For stage ?A or ?C young patients with fertility requirements,fertility-preserving surgery is feasible.Adjuvant chemotherapy can promote prognosis for advanced stage patients.4.Chemotherapy regimens containing platinum is better than other regimens for SCC transformation in MCTO treatment. |
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