Journals / GORM:Gynecology Obstetrics & Reproductive Medicine / 2001 / Cilt: 7 - Sayı: 1
Overin granüloza hücreli tümörleri: 58 olgunun analizi
- Pages
- 54–58
- DOI
- —
Abstract
OBJECTIVE: Analysis of outcome and risk factors for recurrence in 58 granulosa cell tumors. STUDY DESIGN: Sixty patients diagnosed to have granulosa cell tumor between 1984-1998 in the oncology department of SSK Maternity and Women's Health Teaching Hospital included in the study. Patient files, follow-up charts and pathological slides were revised retrospectively and two patients with insufficient data to assign a stage were excluded from the study. All patients had undergone at least a unilateral salpingo-oophorectomy. Clinical parameters of the remaining 58 cases were evaluated such as: age, gravity, parity, symptoms at the time of initial visit, surgical procedure performed, postoperative treatment and follow up. Statistical analyses were performed using SPSS version 9.0 for windows. Pearson chi-square test, Fisher's exact test or the Student t-test was used whenever suitable to analyze two groups. Kaplan- Meier method was used for survival analysis. Stepwise logistic regression analysis model was built using forward wald method in order to determine the most important variable(s) effecting recurrence as the dichotomous variable. RESULTS: Granulosa cell tumors of the ovary constitute 8.8% of all ovarian malignancies diagnosed in this center. The mean age of the study group at the time of diagnosis was found to be 50.3 ± 12.4 years (range: 19-81 years). Abnormal uterine bleeding was the most common presenting symptom (%68.9). Evidence of estrogen production was observed in 26 (%45) patients including three endometrial carcinoma and 23 endometrial hyperplasia. Most patients were stage I (83%). No lymph node metastasis was observed in tumors confined to the ovaries macroscopically (intraoperatively assumed stage I granulosa cell tumor) despite paraaortic lymphadenectomy in 25 cases. Recurrent disease was observed in four patients with stage I disease (8.3%) and two patients with advanced disease (other than stage I). Logistic regression analysis revealed that only stage significantly increases the risk of recurrence (OR: 2.4, CI: 1.07- 5.3, p= 0.03). Age, menopausal status, mode of treatment after initial surgery (categorized as follow up, radiotherapy and chemotherapy), paraaortic lymph node dissection, degree of histologic differentiation were not significant in the model. Patients with stage I disease were found to have a 91% disease free five year survival rate while it was 72% in patients with advanced disease (log rank: 4, p=0,04). Death due to disease was evaluated and total survival rate was found to be 100% for stage I and 72% for advanced disease (log rank :8.2, p=0.004). Patients that received platinum based chemotherapy were found to have an 85% five year disease free survival which was not statistically different from the surgery only group with 100% disease free survival (log rank: 2.5, p=0.1). COCLUSION: Bilateral salpingo-oophorectomy in stage I patients and aggressive cytoreductive surgery in recurrent tumours seems beneficial for the patient but the role of platinum based adjuvant chemotherapy in stage I disease is yet to be determined. (Gynecol Obstet Reprod Med 2001; 7:54-58)
Özet
Bu çalışmada overin granüloza hücreli tümörü saptanan 58 olgunun analizi yapıldı. Hastaların analizinde Pearson ki-kare testi, Fisher'in exact testi, t-test, Lojistik regresyon analizi ve Kaplan-Meier yaşam analizi kullanıldı. Granüloza hücreli tümörler merkezimizde tanı alan over tümörlerinin %8.8' ini oluşturuyordu. Yaş ortalaması 50.3 ± 12.4 olan hasta grubumuzda en sık başvuru şikayeti anormal uterin kanama idi (%68.9). Üç endometriyum kanseri ve 23 endometriyal hiperplazi olmak üzere yirmialtı olguda aşırı estrojen üretiminin göstergesi kabul edilen bulgular vardı. İntraoperatif gözlemde makroskopik olarak overe sınırlı görülen ve daha sonra evre I olarak tanısı kesinleşen 25 olguya yapılan paraaort i k lenf nodu disseksiyonlarının hiçbirinde tümör metastazına rastlanmadı. Evre I olguların dördünde (%8.3) evre I dışındaki ileri evre olguların ise ikisinde rekürrens izlendi. Hasta yaşı, menapozal durum, ilk cerrahi sonrası tedavi yaklaşımı (sadece izlem , radyoterapi, kemoterapi), paraaortik lenf nodu disseksiyonu, histolojik grup ve hastalık evresinin dahil edildiği lojistik regresyon analizinde sadece evrenin rekürrens riskini anlamlı olarak arttırdığı bulundu (OR: 2.4, CI: 1.07-5.3, p=0.03). Evre I olg u ların beş yıllık hastalıksız yaşam oranı %91 bulunurken, ileri evre olgularda bu oran %72 bulundu ( log rank:4, p=0.04). Hastalığa bağlı ölümler araştırıldığında evre I olgular için beş yıllık yaşam %100, ileri evre olgular için ise %72 olarak bulundu ( l o g rank: 8.2, p=0.004). Evre I olgularda primer cerrahi sonrası platin bazlı kemoterapi alan 24 olgu sadece izlenen olgularla karşılaştırıldığında, platin bazlı tedavi alan olgularda hesaplanan %85 beş yıllık hastalıksız yaşamın sadece izlenen olgulardaki % 100' lük beş yıllık hastalıksız yaşamdan istatistiksel olarak farklı olmadığı bulundu (log rank: 2.5, p=0.1). Bu çalışmanın sonucunda evre I olgularda sadece bilateral salpingooferektominin yeterli olacağı, rekürren tümörü olan olguların agresif sitoredüktif cerrahiden yarar gördüğü sonucuna ulaşıldı. Evre I olgularda ise platin bazlı kemoterapinin rekürrens üzerine etkisinin saptanabilmesi için granüloza hücreli tümörler gibi yavaş büyüyen ve geç rekürrens gösteren tümörlerde on yıllık izlemlere ihtiyaç olduğu düşünüldü.