Objective: To compare the survival outcomes between surveillance and adjuvant chemotherapy in patients with stage Ⅰ ovarian immature teratoma (IMT) underwent fertility-sparing surgery. Methods: Clinical and pathological records of patients with stage Ⅰ ovarian IMT between Jan. 2011 to Feb. 2023 were collected from Peking Union Medical College Hospital, except stage Ⅰa grade 1. The consultation of risks and benefits regarding adjuvant chemotherapy was conducted by gynecologic oncologists. A shared decision about surveillance or chemotherapy was made by physician and patients or their guardians. Patients who finally decided to undergo surveillance were included in the surveillance group (n=40), the others were included in the adjuvant chemotherapy group (n=63). Clinical characteristics, treatment and survival outcomes were analyzed and compared between two groups. Results: A total of 103 patients were included. The median age of initial diagnosis was 20 years old (range: 3-39 years old), and the median follow-up time was 31 months (range: 1-254 months). The age, International Federation of Gynecology and Obstetrics (FIGO) stage, pathological grade, surgical method, and preoperative and postoperative alpha-fetoprotein levels in the surveillance group and the adjuvant chemotherapy group were similar (all P>0.05). The surgical approach and maximum tumor diameter between two groups were significantly different (all P<0.05). Forty patients of the surveillance group were identified, only one patient with stage Ⅰa grade 2 IMT who underwent cystectomy had malignant recurrence on the same ovary. Another 63 patients received adjuvant chemotherapy after surgery, five patients had malignant recurrence, and two of them died of disease progression after relapsed. There were no significant differences in disease-free survival (DFS;20 vs 36 months) and overall survival (OS; 23 vs 39 months) between the surveillance group and the adjuvant chemotherapy group (follow-up time censored at 72 months; DFS: P=0.325, OS: P=0.278). Conclusions: There are no differences in survival outcomes between patients with stage Ⅰ ovarian IMT underwent adjuvant chemotherapy or not. Active surveillance might be safe and preferable in stage Ⅰ IMT patients underwent complete resection of tumor.
目的： 对比Ⅰ期卵巢未成熟畸胎瘤（IMT）患者接受保留生育功能手术后密切随诊与辅助化疗之间预后的差异。 方法： 收集2011年1月至2023年2月在中国医学科学院北京协和医院接受保留生育功能手术（保留子宫和至少一侧附件）的Ⅰ期（Ⅰa期G1除外）卵巢IMT患者的临床病理资料。由妇科肿瘤专家进行有关辅助化疗风险和获益的咨询，医师和患者及其监护人共同做出术后密切随诊或辅助化疗的决定。最终将患者分为密切随诊组和辅助化疗组，比较两组患者的临床病理特征及预后。 结果： 本研究共纳入103例Ⅰ期IMT患者，中位年龄为20岁（范围：3~39岁），中位随访时间31个月（范围：1~254个月）；密切随诊组40例，辅助化疗组63例。两组患者的年龄、国际妇产科联盟（FIGO）分期、病理分级、手术方式、术前和术后甲胎蛋白水平分别比较，差异均无统计学意义（P均>0.05）；而两组患者的手术途径、肿瘤最大径分别比较，差异均有统计学意义（P均<0.05）。40例密切随诊组患者中，仅1例初次治疗时接受卵巢肿瘤剔除术的Ⅰa期G2卵巢IMT患者出现同侧卵巢的恶性复发；63例辅助化疗组患者中，5例出现恶性复发，其中2例患者死于复发后疾病进展。密切随诊组与辅助化疗组患者的中位无病生存（DFS）时间（分别为20、36个月）和总生存（OS）时间（分别为23、39个月）分别比较，差异均无统计学意义（随访时间截尾值均为72个月；DFS：P=0.325，OS：P=0.278）。 结论： Ⅰ期卵巢IMT患者保留生育功能手术后，接受与未接受辅助化疗患者之间的预后无显著差异。对于Ⅰ期卵巢IMT患者，在手术完整切除肿瘤后进行密切随诊可能是相对安全且可行的。.