Clinical Retrospective Analysis And Prognostic Significance Anglysis Of Lymphadenectomy Of 72 Malignant Ovarian Sex Cord Stromal Tumors

Objectives.To evaluate the prognostic significance of lymphadenectomy in malignant ovarian sex cord stromal tumor(SCST).Methods.The medical records of patients with malignant ovarian SCST who underwent primary surgery from April 2005 to December 2016 were retrospectively reviewed in the Department of Obstetrics and Gynecology of Qilu Hospital.The clinical data of 72 patients with ovarian SCST were statistically analyzed using software SPSS 19.0.Kaplan-Meier survival curve and Log-Rank test were used to detect differences between two groups,and the COX proportional hazards regression model was used for multivariate analysis.To evaluate the prognostic significance of lymphadenectomy in malignant ovarian sex cord stromal tumor.A meta-analysis was performed by searching the PubMed and Embase database up to July 2017,and the language was restricted to English.Pooled odds ratios(ORs)and 95%confidence intervals(CIs)were calculated by STATA statistical software version 12.0.Results.Seventy-two patients with malignant SCST were identified in our institution.The mean age of thepatients was 44.3 years(range,8-80 years).Among the 72 patients,50 had granulosa cell tumors(GCTs,69.4%).Of the 50 patients with GCT,39 of them were adult type and 11 were juvenile type.18 had Sertoli-Leydig cell tumors(25%);2 had Steroid cell tumor(2.8%);the rest 2 patients each had sex cord tumor with annular tubules and SCST not other wise specified according to 2014 WHO Classification of Tumors of Female Reproductive Organs.Of the 72 patients in this study,64(88.9%)were early stage(?-?),and 8(11.1%)were advanced stage(?-?).Among the 72 patients,22(30.6%)were received conservative surgery,and 50(69.4%)had radical surgery.Of the 72 patients,34(47.2%)underwent lymphadenectomy,and 38(52.8%)did not undergo the surgery.None of the lymph nodes had pathologically confirmed metastasis.Among the 72 patients,45(62.5%)received chemotherapy after surgery,and 27(37.5%)were not.During follow-up,1 patients died of not achieving clinical alleviate,and 4 patients observed recurrence.Recurrence manifestation including elevated llevel of CA-125,pelvic mass and hepatic metastasis.Tumorectomy and chemotherapy was performed among recurrence disease.4 of 72 patients died in total during follow-up.Kaplan-Meier and Long-Rank test results show that only tumor stage show statistically significance in Overall survival(P=0.010).while age(P=0.880),pathologic types(P=0.405),tumor diameter(P=0.376),lymphadenectomy(P=0.734),extent of surgery(P=0.125),chemotherapy(P=0.769),and tumor rupture(P =0.447)show no statistically significance in improving Overall survival.COX multivariate analysis results were consistent with the univariate analysis,and tumor stage(P=0.032)waa an independent risk fator affecting overall survival.In our meta-analysis,108 studies from Pubmed database and 71 studies from Embase database were identified through a proper search strategy,and 13 studies were included eventually;3223 cases were identified,including those from our institution.Among those studies,1378(42.8%)of them underwent lymphadenectomy,and 1842(57.2%)did not undergo the surgery.lymph node metastic rate was 3.5(36/1033).The random-effects model was used because of moderate heterogeneity(x2=23.13,I2=43.8%,P=0.040).The estimated pooled OR was 0.87(95%CI,0.57-1.31),indicating that lymphadenectomy has no statistical significance in improving overall survival in SCSTs(Z=0.68,P=0.496).Conclusions.Malignant ovarian SCST is a rare disease,the onset age is low with an average of 44 years old.Most disease are early stage(FIGO ?-?)when first diagnosed.Typical clinical symptoms including pelvic masses,abnormal vaginal bleeding,abdominal pain,and abdominal distension.Ultrasonography tend to show solid mass or solid-cyst mixed mass in pelvic,most of them contain blood flow signal.The diagnosis is lack of specific tumor markers,and some patients may have a mild elevated level of serum CA-125.Hysterectomy and bilateral salpingo-oophorectomy should perform in patients with malignant SCST.For young patients with stage ? A or I C SCST who deseire preservation of fertility,fertility sparing surgery is the appropriate approach.Radical surgery should be perfoemed after patient complete their reproductive fuction.Postoperative adjuvant chemotherapy or radiotherapy should be decided when consider patients' specific situation.SCST have an indolent nature and overall a good prognosis,and tumor stage is the single most important prognositic factor sffecting its overall survival.The lymph node metastasis rate in SCSTs is extremely low,and there is no significanceeffect of lymphadenectomy in improving the overall survival of SCSTs.Lymphadenectomy is not recommended in initial surgery unless lymph node abnormality.