【摘要】：目的:分析卵巢顆粒細胞瘤的臨床病理特征,探討影響卵巢顆粒細胞瘤預后及復發(fā)的相關因素。方法:1收集并分析了2005年1月至2016年6月于河北醫(yī)科大學第四醫(yī)院診治的112例卵巢顆粒細胞瘤患者的臨床病理資料,包括初診年齡、臨床表現、生育情況、術前血清腫瘤標志物、婦科B超、手術方式、手術途徑、腫瘤分期、腫瘤病理特點、術后化療,術后復發(fā)、復發(fā)后治療以及術后生育狀況等,通過電話及書信等方式進行隨訪。2通過SPSS21.0軟件建立數據庫并進行統(tǒng)計學分析。結果:1一般情況:112例病例資料中,包括成人型卵巢顆粒細胞瘤(AGCT)107例,幼年型卵巢顆粒細胞瘤(JGCT)5例,卵巢顆粒細胞瘤(GCT)患者的平均年齡為46.5±13.93歲,年齡范圍為12-75歲。術前血清學CAl25平均水平為118.11±415.61IU/mL,其中有38.50%(35/91)升高。2手術情況:不保留生育功能手術83例(74.10%),手術方式包括:雙側卵巢切除、雙側附件切除或行全子宮切除術。保留生育功能手術29例(25.90%),16例(55.20%)行單側或雙側卵巢腫瘤剝除術、13例(44.80%)行單側附件切除術。47例(42.00%)患者行全面分期手術。112例患者中有37例(33.00%)患者行腹腔鏡手術,75例(67.00%)行開腹手術。3輔助化療:83例患者接受術后輔助化療,療程為1-16,方案主要為以鉑類(順鉑、卡鉑、奧沙利鉑等)為主的靜脈聯合化療,化療方案有BEP、VAC、TP、TC等。4病理特點:卵巢顆粒細胞瘤最大徑線平均為9.25±5.45cm,(1.60cm-48.00cm)。腫瘤位于雙側者2例(1.80%),單側腫瘤者110例(98.20%)。112例患者重新以最新版FIGO分期標準進行分期,分期結果示:I期105例、II期4例、III期3例,淋巴結均未出現轉移。5復發(fā)情況:112例患者的平均隨訪時間為52.63±37.82個月,有11例(9.80%)患者于隨訪期內復發(fā),平均復發(fā)時間間隔為83.09±59.92個月(24-228個月)。6生存分析:截止隨訪期結束,死亡病例數為7例(6.30%),均因本疾病去世,112例患者中隨訪時間滿5年的患者有42例(37.50%),其中6例患者死亡,1例患者第10年死亡,隨訪期滿10年患者15例(13.39%),7例患者死亡,其中1例死亡患者為Ⅱ期。Ⅰ期GCT的5年生存率和10年生存率分別為85.71%和57.14%。結論:1血清CA125水平不能診斷AGCT和JGCT,但合并腹水患者CA125較無腹水者明顯升高。2腫瘤復發(fā)可導致5年無疾病生存期縮短。3 GCT患者FIGO分期越晚,越容易復發(fā)。4Ⅰ期患者有高危因素化療可延長患者生存期。5復發(fā)患者行滿意腫瘤細胞減滅術聯合化療可延長患者生存期。
[Abstract]:Objective: to analyze the clinicopathological features of granulosa cell tumor of ovary and to explore the related factors of prognosis and recurrence of granulosa cell tumor of ovary. Methods from January 2005 to June 2016, we collected and analyzed the clinicopathological data of 112 patients with ovarian granulosa cell tumor treated in the fourth Hospital of Hebei Medical University, including age, clinical manifestation and fertility. Preoperative serum tumor markers, gynecological B-mode ultrasound, surgical approach, tumor staging, tumor pathological features, postoperative chemotherapy, postoperative recurrence, post-recurrence treatment and post-operative fertility, etc. Follow-up by phone and letter. 2. Establish database and statistical analysis by SPSS21.0 software. Results of the 112 cases, 10 7 were adult granulosa cell tumor (AGCT) and 5 were juvenile granulosa cell tumor (JGCT). The average age of (GCT) patients with ovarian granulosa cell tumor was 46. 5 鹵13. 93 years, and the age range was 12 to 75 years old. The mean preoperative serological CAl25 level was 118.11 鹵415.61 IU / mL. 38.50% (35 / 91) of them had increased 2.2. operation: 83 cases (74.10%) were operated without preserving reproductive function. The operative methods included bilateral ovariectomy, bilateral appendage resection or total hysterectomy. Of 29 cases (25.90%), 16 cases (55.20%) underwent unilateral or bilateral ovarian tumor excision, 13 cases (44.80%) underwent unilateral adnexectomy. 47 cases (42.00%) underwent comprehensive staging surgery. 37 cases (33.00%) underwent laparoscopic surgery, 75 cases (67.00%) underwent laparoscopic surgery. Postoperative adjuvant chemotherapy was performed in 83 patients with 3 cases of adjuvant chemotherapy after open surgery. The course of treatment was 1-16. The main regimen was intravenous chemotherapy with platinum (cisplatin, carboplatin, oxaliplatin, etc.). The chemotherapy regimen had BEP,VAC,TP,TC and other pathological characteristics: the average maximum diameter of granulosa cell tumor was 9.25 鹵5.45 cm, (1.60cm-48.00cm). Two cases (1.80%) of tumors were located on both sides and 110 cases (98.20%) of unilateral tumors were re-staging according to the latest FIGO staging standard. The mean follow-up time was 52.63 鹵37.82 months, 11 cases (9.80%) recurred during the follow-up period, the mean recurrence interval was 83.09 鹵59.92 months (24-228 months), and the mean survival time was 83.09 鹵59.92 months (24-228 months). There were 7 cases (6.30%) died, 42 cases (37.50%) were followed up for more than 5 years, 6 cases died in the tenth year, and 15 cases (13.39%) died in 10 years. The 5-year and 10-year survival rates of stage 鈪，

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