Prognostic factors for pure ovarian immature teratoma and the role of adjuvant chemotherapy in stage I diseases

The prognostic factors for patients with pure ovarian immature teratoma (POIT) and the role of adjuvant chemotherapy in stage IA G2-G3 and IB-IC POIT remains controversial. We conducted a retrospective study of 155 POIT patients treated in our hospital between 2000 and 2022. The recurrence-free survival (RFS), disease-specific survival (DSS), and potential prognostic factors of POIT patients were evaluated. Subgroup analysis was conducted in stage I other than stage IA G1 POIT. The median age at diagnosis was 23.0 years (range: 4.0 − 39.0), and 126 (81.3%), 2 (1.3%), 26 (16.8%), and 1 (0.6%) patients had FIGO stage I, stage II, stage III, and stage IV disease, respectively. Twenty-three patients relapsed and five died of the diseases after a median follow-up of 7.6 years, with a 5-year RFS and DSS rate of 86.0% and 97.0%, respectively. Multivariate analysis showed that positive postoperative tumour markers (TM) were the risk factor for recurrence in the overall cohort (hazard ratio [HR] 4.058, 95% CI 1.175 − 14.019, <i>p</i> = 0.027) and subgroup (HR 10.237, 95% CI 2.175 − 48.179, <i>p</i> = 0.003), and FIGO stage II–IV was the only factor for DSS in overall cohort (HR 7.751, 95% CI 1.281 − 46.895, <i>p</i> = 0.026). In 110 patients subjected to subgroup analysis, 29 patients received surveillance without chemotherapy and 81 patients were administered adjuvant chemotherapy. Multivariate analysis revealed active surveillance significantly increased the recurrence rate (5-year RFS of 75.7% vs. 93.6%, HR 7.562, 95% CI 2.441 − 23.424, <i>p</i> &lt; 0.001) but not the death related to POIT (<i>p</i> = 0.338). Positive postoperative TM and FIGO stage II–IV were the prognostic factors for POIT. Active surveillance in stage I POIT of any grade may be practical for those with negative postoperative TM. Positive postoperative tumour markers and FIGO stage II–IV were the prognostic factors for pure ovarian immature teratoma. Active surveillance in stage I pure ovarian immature teratoma of any grade may be practical for those with negative postoperative tumor markers.

纯卵巢未成熟畸胎瘤（pure ovarian immature teratoma, POIT）患者的预后影响因素，以及辅助化疗在IA期G2-G3和IB-IC期POIT患者中的应用价值仍存在争议。本研究回顾性分析了2000年至2022年间于我院接受治疗的155例POIT患者的临床资料，评估了患者的无复发生存期（recurrence-free survival, RFS）、疾病特异性生存期（disease-specific survival, DSS）以及潜在的预后影响因素，并针对除IA期G1型POIT之外的I期患者开展了亚组分析。
确诊时患者的中位年龄为23.0岁（范围：4.0~39.0岁）；其中FIGO分期I期、II期、III期、IV期的患者分别为126例（81.3%）、2例（1.3%）、26例（16.8%）和1例（0.6%）。中位随访时间为7.6年，期间共有23例患者复发，5例因该病死亡；整体人群的5年无复发生存率和5年疾病特异性生存率分别为86.0%和97.0%。
多因素分析结果显示，在整体队列及亚组分析中，术后肿瘤标志物（tumour markers, TM）阳性均为复发的独立危险因素（整体队列：风险比[hazard ratio, HR]=4.058，95%置信区间[confidence interval, CI]：1.175~14.019，P=0.027；亚组：HR=10.237，95%CI：2.175~48.179，P=0.003）；而在整体队列中，FIGO分期II~IV期是影响疾病特异性生存期的唯一独立危险因素（HR=7.751，95%CI：1.281~46.895，P=0.026）。
在纳入亚组分析的110例患者中，29例仅接受密切随访而未行辅助化疗，81例接受了辅助化疗。多因素分析显示，主动监测策略会显著升高复发风险（5年无复发生存率：75.7% vs. 93.6%，HR=7.562，95%CI：2.441~23.424，P<0.001），但并未显著增加与POIT相关的死亡风险（P=0.338）。
术后肿瘤标志物阳性及FIGO分期II~IV期是POIT的独立预后影响因素。对于术后肿瘤标志物阴性的任何分级I期POIT患者，采用主动监测策略或许是可行的。
术后肿瘤标志物阳性及FIGO分期II~IV期是纯卵巢未成熟畸胎瘤的独立预后影响因素。对于术后肿瘤标志物阴性的任何分级I期纯卵巢未成熟畸胎瘤患者，采用主动监测策略或许是可行的。