| Objective:To investigate the clinicopathologic characters,treatments and prognostic factors of malignant ovarian sex cord-stromal tumors.Method:Retrospectively analyze the clinical characteristics and prognosis of 75 patients with malignant ovarian sex cord-stromal tumors who accepted the initial surgical treatments in Qilu Hospital of Shandong University from Jan.2005 to Dec.2016.Mann-Whitney's rank-sum test was used to compare the early-stage patients with advanced patients to see whether their preoperative serum CA-125?CA-153?CEA levels have differences.Recurrence rate was compared by Fisher exact test and ?2 test.Survival analysis was performed by Kaplan-Meier method and survival curve was calculated by log-rank method.P<0.05 was statistically significant.Result:1.Age and symptomsThe age of 75 patients with malignant ovarian sex cord-stromal tumors was from 11 to 82 years.The mean age was 43.86 years and the median age was 44 years.45 patients of them were premenopausal and 30 patients were postmenopausal.The main initial symptoms were abnormal vaginal bleeding(34.67%),pelvic mass(32%),abdominal pain(21.33%),amenorrhea(10.67%)and infertility(1.33%).2.Pathological pattern and FIGO stageAmong the 75 patients with malignant ovarian sex cord-stromal tumors,46 cases(61.33%)were AGCT,9 cases(12%)were JGCT and 20 cases(26.67%)were SLCT.According to 2013 FIGO stage,67 cases were in stage I,2 cases were in stage II,5 cases were in stage ? and 1 case was in stage ?.3.Assistant examinationThere were 75 patients received ultrasound examination,the result shows that most of the patients' tumors were located on the unilateral,including 38 cases of left ovary and 36 cases of right ovaries.Only 1 case of granular cell tumor occurred in bilateral ovaries.The serum CA-125 was detected in 71 patients before operation and elevated CA-125(?35U/ml)was found in 20 cases,including 16 cases in stage 1,3cases in stage?,1 case in stage ?.The preoperative serum CA-125 levels between early stage and advanced patients existed significant difference(Mann-Whitney's rank-sum test,Z=-2.315,P=0.018).While the preoperative serum CA-199 and CEA levels between early stage and advanced patients did not have significant difference.4.TreatmentAll of the 75 patients underwent surgery therapies which include 21 cases of fertility-sparing surgeries and 37 cases underwent pelvic lymphadenectomies.49 patients received chemotherapy after their surgeries.28 patients received less than 3 courses and 21 patients received 4-6 courses.24 patients were treated with chemotherapy regimen of TC(Carboplatin+Paclitaxel),21 patients were treated byBEP(Bleomycin+Etoposide+Cisplatin)and 4 patients were treated with BVP(Bleomycin+Vincristine+ Cisplatin).5.Postoperative pathologyThe tumor diameter of 44 patients were less than 10 centimeters while 31 patients were more than 10 centimeters.37 cases underwent pelvic lymphadenectomy,we did not find lymph nodes metastasis.We received 54 pieces of endometrial tissues,10 cases were proved with endometrial lesions which included 7 cases of endometrial polyp,2 cases of endometrial simple hyperplasia and1 case of endometrial complex hyperplasia.6.Follow upAt the end of follow up(12-144months),9 cases(13.24%)replapsed,7 cases(9.3%)were lost to follow up,4 cases(5.88%)died.Among the 21 cases who underwent fertility-sparing surgeries,10 cases did not have fertility plans,5 cases were lost to follow up,4 cases had pregnant and had their babies,2 cases were spinsterhoods.7.Analysis of prognostic factorsClinical stage(P=0.012),tumor diameter(P=0.024)and ovarian tumorectomy(P=0.024)are the single factors affecting the recurrence rate of patients with malignant ovarian sex cord-stromal tumors.Clinical stage(P<0.01)is the independent factor affecting the survival rate of patients with malignant ovarian sex cord-stromal tumors.There were not difference in survival rate between patients age(p=0.361),menopause or not(p=0.560),tumor diameter(p = 0.641),histological type(p=0.218),acceptted fertility-sparing surgery or not(P=0.551),accepted pelvic lymphadenectomy surgery or not(p=0.832),accepted chemotherapy or not(P=0.430).Conclusion:1.The prognosis of malignant ovarian sex cord-stromal tumor is good.Most of the tumors are located on the unilateral.Patients are mostly hospitalized for abnormal vaginal bleeding and most people are in stage ? when they are treated;2.Malignant ovarian sex cord-stromal tumors has low lymphatic metastasis,so lymphadenectomy is not necessary for patients with this disease,Fertility-sparing surgery is feasible for the young patients in stage ?.3.Clinical stage is an important prognostic factor for patients with malignant ovarian sex cord-stromal tumors.Turner's diameter over 10 cm and ovarian tumorectomy are risk factors for patients' recurrence,but active surgical treatment after recurrence can improve the prognosis.4.Postoperative chemotherapy had no effect on prognosis of patients in stage ?. |
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