(I) Treatment
Pediatric ovarian tumors should be removed surgically at an early stage. Bilateral ovaries should be explored during surgery, and if the lesion is bilateral, the tumor should be removed and one ovarian tissue should be preserved as much as possible. Even if the tumor is malignant, pelvic debulking is generally not advisable. Comprehensive treatment of ovarian malignant tumor mainly by surgery, supplemented by chemotherapy is of great importance, and radiotherapy and other treatments are given as appropriate.
1.Treatment
(1) Surgical treatment.
①Comprehensive staging laparotomy.
A. Longitudinal abdominal incision (from the pubic symphysis to 4 fingers above the umbilicus).
B. Full exploration.
C. Abdominal cytology (ascites or pelvic, lateral colonic sulcus, diaphragmatic washout).
D. Large omentum resection.
E. Total hysterectomy with double adnexa + appendectomy.
F. Pelvic and abdominal exploration and biopsy (adhesions, suspicious lesions, diaphragm, liver, intestinal plasma membrane, mesentery, pelvic lateral peritoneum).
G. Pelvic and para-aortic lymph node dissection (to the level of the inferior mesenteric artery).
② re-staging lapanotomy: refers to the first operation without exact staging. McGoWan found that only 54% of ovarian cancer patients underwent full surgical staging at the time of the first surgery, and Young et al. reported a 3% increase in re-staging surgery in patients initially diagnosed with early-stage ovarian cancer.
(iii) cytoreductive surgery: the best efforts are made to remove the primary lesion and all metastases so that the residual cancer is <2 cm in diameter. the scope of surgery includes
A. The surgical incision is a sufficiently large longitudinal incision.
B. Cytology of ascites or peritoneal washings.
C. Total hysterectomy, bilateral adnexal and pelvic mass resection, and ovarian chordae with high ligation.
D. Large omentum resection with attention to liver, spleen, diaphragm, lateral colonic sulcus, pelvic wall peritoneum, mesenteric and uterine rectal fossa metastases resection or multi-point biopsy.
E. Abdominal para-aortic and pelvic lymph node dissection.
F. Appendectomy and involved intestinal canal resection and intestinal anastomosis or fistula.
G. Removal of pelvic organs (bladder or rectal involvement).
The degree of initial surgical completeness directly affects the efficiency and survival of chemotherapy. the Griffiths subgroup controlled study illustrated that the complete efficiency (CR) of chemotherapy after tumor cytoreduction was 43% and 24% for ideal and suboptimal, respectively. Many oncologists, such as Ozols and Griffiths, believe that removing as much of the visible tumor as possible will improve outcomes.
(4) “Intermediate” or interval cytoreductive surgery: Some advanced ovarian cancers are estimated to be difficult to excise and are treated with several courses of chemotherapy (less than 6 courses of non-full course) followed by cytoreductive surgery. This may make the tumor reduction surgery easier to perform, but it is not good for postoperative chemotherapy. For those with large, fixed tumors and large amount of ascites, 1 to 2 courses of chemotherapy should be administered first, which is called prior chemotherapy to reduce ascites, shrink the mass and loosen the mass, which can improve the quality of surgery.
⑤ Re-cytoreductive surgery: It refers to surgery for residual tumor or recurrent tumor, but without effective second-line chemotherapy drugs, the value of this surgery is limited. 1995 European case-group controlled study, after 3 courses of DDP+CTX chemotherapy for those who failed to achieve ideal tumor reduction surgery, secondary tumor reduction surgery was performed. The postoperative survival was 41.6 months for residual tumors <1 cm, 26.6 months for those >1 cm, and 20 months for those who did not undergo secondary reduction, with significant differences between the three groups. This indicates that reoperation has some significance.
(⑥) Second look operation: It refers to those who have undergone at least 6 courses of chemotherapy within 1 year after ideal tumor cell reduction and have no evidence of tumor recurrence by clinical physical examination and adjuvant or laboratory tests (including CA125 and other tumor markers), and then undergo another dissection.
A. Its purpose: To find out whether there is any residual cancer foci in the abdominal cavity in order to decide whether to
a. stop chemotherapy or reduce the number of treatment courses for consolidation purpose.
b. Change the chemotherapy regimen or treatment method.
c. Removal of all cancer foci.
B. Exploratory procedure content: secondary exploratory procedure content includes
a. Full exploration and biopsy.
b. Cytological examination of abdominal irrigation fluid.
c. Biopsy of the pelvis, both pelvic walls, lateral colonic sulcus, bladder fossa, rectal fossa, greater omentum and root of pelvic funnel ligament, mesentery, intestinal plasma membrane, suspicious nodes of greater omentum and suspicious retroperitoneal lymph nodes.
There are no prospective data showing that secondary exploration has significantly prolonged patient survival and reduced recurrence rates. Some studies have confirmed that 40% to 60% of patients with negative secondary exploration recur, and recurrence occurs mostly within 3 years after surgery, and recurrence is related to the clinical stage of the tumor, cellular grade, and the extent of residual tumor from the initial surgery. Therefore, secondary exploratory surgery is not routinely advocated. Secondary exploratory surgery can be used selectively in some patients as a judgment of the effect of chemotherapy; or some patients with elevated CA125 but no clinically detected lesions, especially those with high risk (recurrence) of tumor grade G3 and large residual tumor from the initial surgery. In contrast, secondary exploratory surgery is not recommended for junctional tumors, stage I epithelial tumors, malignant germ cell tumors, and sex cord mesenchymal tumors. The recurrence rate of secondary exploratory surgery with laparoscopy is high and cannot replace secondary exploratory surgery.
(2) Chemotherapy.
(1) Indications: Chemotherapy is an important treatment measure for advanced ovarian cancer and must be timely, adequate and standardized. Chemotherapy is the guarantee of surgical efficacy, and one of the two methods is indispensable. Except for stage IA highly differentiated tumors, all other stage IB and above should be treated with adjuvant chemotherapy after surgery. Chemotherapy should also be considered for stage IA pathological grade 3 (G3).
The efficacy of chemotherapy is related to the size of the residual tumor from the initial tumor cytoreductive surgery, and the smaller the residual tumor, the better the efficacy. In the US GOG study, the 4-year survival rates after chemotherapy were 60%, 35% and 20% for those with no residual tumor on the naked eye, residual tumor ≤2 cm and residual tumor >2 cm, respectively.
②Commonly used chemotherapy drugs: melphalan (L-PAM), cyclophosphamide (CTX), isocyclic amide (IFO), cetapide (TSPA), hexamethonium (HMM), doxorubicin (Adriamycin), fluorouracil (5-Fu), methotrexate (MTX), cisplatin (DDP), carboplatin (CBP), paclitaxel (Taxol), actinomycin D (vincristine), bleomycin (BLM), tobotulin (TPT), vincristine (VCR), etoposide (pedialyte glycoside, Vp-16), nitrocarbamide (abscisicin, CLB).
(③) Common chemotherapy regimens: There are many chemotherapy regimens for the treatment of ovarian cancer, and different regimens should be selected according to the pathological type of the tumor. It is generally considered that combination chemotherapy is superior to single agent chemotherapy and is usually mostly used for.
A. epithelial ovarian malignant tumors
B. germ cell tumors
C. germ cell tumors: commonly used chemotherapy regimens are PAC regimen, VAC regimen and VBP regimen.
D. Metastatic ovarian cancer: chemotherapy regimens using primary tumor chemotherapy regimens.
DDP-based combination chemotherapy regimens have been widely used to treat ovarian cancer, with an overall efficiency of 70% to 80%, 40% to 50% achieving clinical complete remission (CR), and 25% of them surviving tumor-free for more than 5 years. The PAC and PC regimens are currently used most frequently for epithelial cancer as first-line standard chemotherapy regimens, while the TP regimen is used in Europe and the United States for advanced ovarian cancer and has the highest efficiency (Table 4).
④ Chemotherapy route and duration: The chemotherapy route should be mainly systemic chemotherapy (intravenous or oral), but can also be combined with abdominal chemotherapy and arterial cannulation chemotherapy or interventional chemotherapy.
A. Indications for abdominal chemotherapy for ovarian cancer: residual tumor at the time of initial tumor cytoreduction for advanced ovarian cancer is: microscopically positive; the maximum diameter of the residual tumor by the naked eye is ≤0.5~1 cm, abdominal chemotherapy as part of the first-line chemotherapy.
High-risk ovarian cancer (stage I, grade 3; stage II): cases that may have microscopic positivity in the epigastrium that is invisible to the naked eye; abdominal chemotherapy as part of first-line chemotherapy.
Patients with high-risk (recurrent) ovarian cancer (stage III, grade 3), but with surgically confirmed, fully effective chemotherapy (CR), with abdominal chemotherapy as consolidation chemotherapy.
Clinical examination and tumor markers are negative (chemotherapy effective) after first-line chemotherapy, and second exploratory surgery reveals: positive microscopy; small residual tumor in the sarcoid, and ventralization as second-line treatment.
Cisplatin (DDP) or carboplatin (CBP) is commonly used for ventral chemotherapy, and the intra-abdominal concentration is 10-20 times greater than that of intravenous systemic chemotherapy, and the ventral concentration of paclitaxel (Taxol) is 1000 times greater than that of intravenous systemic chemotherapy.
B. Arterial cannulation chemotherapy or interventional chemotherapy: the advantage is that the drug is concentrated in the tumor blood supply area, the local drug concentration of tumor is higher than intravenous chemotherapy and the side effects are less, it is suitable for ovarian cancer with difficult resection in advanced stage without surgery or chemotherapy, generally 1 to 2 times of chemotherapy followed by surgery, the efficiency is basically the same as intravenous chemotherapy.
C. Duration of chemotherapy: epithelial ovarian cancer generally requires 6-8 courses of treatment, while germ cell tumors require 3-6 courses of treatment, the number of courses of treatment also depends on the chemotherapy regimen and dose used. The number of courses depends on the chemotherapy regimen and dose used. Those with small doses require more courses.
(3) Radiotherapy: It is only used as an adjuvant treatment for ovarian cancer in addition to surgery and chemotherapy. Radiotherapy is the most sensitive for asexual cell tumors and moderately sensitive for granulosa cell tumors, but radiotherapy is generally used for advanced recurrent cases, and is not sensitive enough for other types of ovarian cancer. However, in stage Ic or those with large amount of ascites or minimal residual tumor with microscopic residual tumor or sarcoidosis after initial tumor cytoreductive surgery, intraperitoneal injection of radionuclide can be supplemented to improve the therapeutic effect.
External irradiation: Because the efficiency of platinum-based combination chemotherapy is 60% to 80%, whole abdominal radiotherapy (WAR) has been significantly reduced as the initial treatment for ovarian cancer, but because the recurrence rate after chemotherapy for epithelial ovarian cancer is 2/3 and the long-term efficacy is poor, WAR has made a comeback in recent years. Initially cytoreductive surgery with minimal or no residual tumor, high risk ovarian cancer administered with WAR has a better survival rate, and pelvic radiotherapy also has a role in reducing local recurrence. the WAR dose is 25-30Gy every 4-5 weeks with liver and kidney lead block protection. The pelvic dose is increased to 40-50 Gy in the ovarian area, and the radiotherapy source is usually 60Co or linear gas pedal. Currently, open-field irradiation and moving-strip technique are used to make the radiation response to the intestine light and short, but to achieve a large biological effect.
Currently, 32p (chromium phosphate) is used, which has a half-life of 14.2 days and a penetration of 1.4-3 mm. because of the short penetration distance, it can only be used for small scattered corn-like lesions. Treatment should be started 4 weeks after surgery with 400 ml of intra-abdominal saline drip, followed by a single injection of 32P 15 mCi (milli-curie), and finally 600 ml of saline drip, after which the patient is instructed to change position once every 15 minutes so that 32P is evenly distributed in the abdominal cavity. The method is contraindicated in cases of intra-abdominal adhesions, and the literature reports a high degree of comorbidity, mainly abdominal pain, peritonitis, and severe comorbidity [intestinal perforation and/or intestinal obstruction] requiring surgery
(4) Management of various types and stages of ovarian malignant tumors.
(1) Ovarian junctional tumors or low-grade potentially malignant tumors: Ovarian junctional tumors account for 10% to 15% of ovarian epithelial tumors. The main pathologic classifications are plasmacytotic and mucinous, with approximately 55% of all junctional tumors being plasmacytotic, 40% mucinous, and 5% of other rare types (2% mixed, 2% endometrioid, and approximately 1% clear cell type and bullous neoplasm). Stage I intersection tumors are predominant, accounting for 80% to 90%, with stage I being mostly mucinous and stage III being mostly plasmacytotic. Patients have a younger age of onset, averaging 33-44 years old, and 9% of combined pregnancies.
A. Surgery: It is the most important and basic treatment for junctional tumor. The scope of surgery depends on the patient’s age, fertility status and clinical stage.
Stage IA, young, with fertility requirements: excision of the affected adnexa, contralateral ovarian exploration, abdominal irrigation fluid, cytological examination and multi-point abdominal biopsy, and comprehensive staging. Older or non-reproductive patients or patients with stage IB or IC: total hysterectomy and bilateral adnexal resection and appendectomy.
Patients with stage II, III and IV: perform tumor reduction and maximum possible removal of tumor seen by the naked eye.
B. Adjuvant chemotherapy: There is no randomized group controlled study to confirm the effectiveness of postoperative conventional chemotherapy. Adjuvant chemotherapy should depend on the stage and surgery. Stage I: After completion of unilateral adnexal resection, or total hysterectomy or double adnexal resection, especially cellular DNA is diploid tumor, chemotherapy can be dispensed with. Stage II or above: 3 to 6 courses of regular chemotherapy can be administered after surgery (same protocol as ovarian epithelial cancer).
C. Prognosis and recurrence: junctional tumors have low malignancy and good prognosis, with 5-year overall survival rate and tumor-free survival rate of 80%-90%. The 5-year overall survival rate and tumor-free survival rate are 80%-90%. Among them, the stage I rate is 95%-100%. The recurrence of junctional tumor is late and confined to the abdominal cavity, with a recurrence rate of 10%-15%. Most recurrences occur in patients who are older, clinically advanced, have residual tumors from initial surgery, have peritoneal pseudomucinous tumors, or have heteroduploid DNA tumors. The majority of recurrences of junctional tumors are still junctional in pathology and have a better outcome with reoperation.
Patients with junctional tumors are mostly young patients in early stages with high survival rates. Postoperative estrogen replacement therapy can improve the quality of survival and prevent cardiovascular disease and osteomalacia.
②Management of early-stage ovarian epithelial carcinoma: About 25% of newly diagnosed ovarian carcinomas are clinical stage I. Among them, stage IA and stage IB are the most common. Among them, stage IA, stage IB, well differentiated cells (G1 or G2), and ovarian cancer without any adjuvant therapy have a 5-year survival rate of more than 90%; while those stage Ic and any stage I ovarian cancer with poorly differentiated cells (G3) or with adhesions or clear cell category have a recurrence rate of 30% to 40% and a 5-year mortality rate of 25%. These high-risk (recurrent) ovarian cancers require adjuvant therapy. There is no consensus on adjuvant therapy and the following are considered based on available information.
A. Surgery: a comprehensive stage-determining dissection is the basis for completion of treatment, accurate staging and decision on adjuvant therapy.
B. Highly selective surgery to preserve reproductive function (preservation of uterus and one side of the adnexa): should be treated strictly and cautiously. Refer to the following conditions.
a. Patient is young and strongly desires fertility.
b. Clinical stage IA.
c. Cellular differentiation of G1 or junctional tumors.
d. Normal appearance of the contralateral ovary and negative biopsy.
e.Negative peritoneal cytology.
f. Negative exploratory biopsy or excisional histopathology of high-risk areas (utero-rectal fossa, lateral colonic sulcus, mesentery, diaphragm, greater omentum, retroperitoneal lymph nodes).
g. Follow-up condition is available.
h. Re-surgical removal of the uterus and contralateral adnexa as appropriate after completion of childbirth.
C. Postoperative chemotherapy: Stage IA and IB, cell differentiation G1, cell DNA diploidy of ovarian cancer can not be adjuvant treatment.
Chemotherapy should be given postoperatively to patients with more than 1 of the following high-risk factors for recurrence.
a. Those without precise staging.
b. Clear cell carcinoma, migratory cell carcinoma.
c.Intermediate cell differentiation, hypofractionated (G2, G3).
d.Tumor growth on the ovarian surface (stage IC).
e. Tumor rupture or incomplete envelope (stage IC).
f. Tumor with pelvic adhesions.
g. Positive cytology of ascites or peritoneal washings (stage IC).
Chemotherapy with a combination of cisplatin (DDP) and cyclophosphamide (CTX) (PC regimen) for 3 to 4 courses is appropriate, and ascites can be used for stage IC patients.
D. Postoperative radiotherapy: only for those with ascites but no serious adhesions in the abdominal cavity, 32P intraperitoneal perfusion can be used.
③Advanced ovarian cancer: due to the lack of effective early means, more than 70% of newly diagnosed ovarian cancer is advanced. Surgery and chemotherapy are the basic treatment methods that are missing in the treatment of advanced ovarian cancer.
A. Patients with advanced ovarian cancer should undergo full and complete “tumor cytoreductive surgery” as long as medical conditions allow. This is to achieve clear diagnosis, accurate staging and maximum removal of primary and metastatic tumors. The size of the surgical residual tumor directly affects the efficiency of postoperative chemotherapy, patient survival and survival rate (Tables 5 and 6).
B. The active implementation of “tumor cytoreductive surgery” for stage III ovarian cancer has been studied, but the role of surgery for stage IV patients is currently considered to improve survival only if satisfactory “tumor cytoreductive surgery” is achieved (Table 7).
C. Postoperative adjuvant therapy.
a. 6 courses of chemotherapy or whole abdominal radiotherapy (WAR) for patients with satisfactory surgery without residual tumor on the naked eye or microscopic residual tumor.
b. 6 courses of chemotherapy (mainly intravenous chemotherapy, supplemented by abdominal chemotherapy) for satisfactory surgical patients with residual tumors ≤2 cm.
c. For unsatisfactory tumor cytoreductive surgery, 1 to 3 courses of chemotherapy or “re-tumor cytoreductive surgery” is feasible after partially effective (PR). After the operation, chemotherapy will be continued.
D. Chemotherapy regimen: epithelial ovarian cancer is treated with a combination of platinum-based chemotherapy, mostly PAC and PC regimens. In advanced ovarian cancer, TP regimens are used if economic conditions permit, and have the highest efficiency (Table 8). In conclusion, the overall efficiency of platinum-based chemotherapy is 70% to 80%, and the CR rate is 50% to 60%.
E. High-dose chemotherapy: The current application of cytokines, auto-bone marrow transplantation (ABMT) and peripheral blood stem cell transplantation (PBSCT) technology has greatly increased the dose of anti-ovarian cancer drugs applied. The application of fingostatin (G-CSF) and PBSCT guarantees ultra-high dose chemotherapy than ABMT and significantly reduces the morbidity and mortality of high-dose chemotherapy. high-dose, multi-course chemotherapy for ovarian cancer since the 1990s, reported as first-line conventional chemotherapy followed by consolidation chemotherapy or just as initial first-line chemotherapy, indicates that the most important factor to achieve long-term survival after high-dose chemotherapy is still In the clinical study of Murakami and Shinozura, the 5-year survival rate of high-dose chemotherapy reached 78%-83% in those with no residual surgery, while those with residual tumor in the naked eye only 19%-26%. Currently, high-dose chemotherapy under PBPC technical support as conventional first-line chemotherapy for ovarian cancer is still pending the results of phase II clinical trials.
(5) Malignant germ cell tumors: Malignant germ cell tumors are more common in China, accounting for about 15% of ovarian cancer, while less than 5% in western countries. Most of them are in girls under 20 years old or young girls. They are commonly admitted with acute abdominal symptoms (abdominal pain, tumor rupture, torsion, bleeding). A small number of women with irregular menstruation, pseudo-precocious puberty in young girls or vaginal bleeding symptoms in menopausal women. Malignant germ cell tumors are mainly immature teratomas, endodermal sinus tumors and asexual cell tumors, while embryonal carcinoma and primary choriocarcinoma are rare. This group of tumors is highly malignant but sensitive to chemotherapy, while immature teratoma can be reversed to benign, so the treatment effect is significantly improved. Except for anaplastic cell tumors, which involve both ovaries in 10%-15%, the rest are rarely bilateral. Therefore, resection of a single adnexa is almost a routine procedure for young, juvenile and patients with fertility aspirations. The indications for fertility-preserving surgery are largely unrestricted by stage, but intraoperative diagnosis by rapid frozen section is recommended. In stage I, only the affected adnexa, greater omentum and retroperitoneal lymph nodes are removed. In stages II, III and IV, if the uterus and contralateral adnexa are normal, resection of the metastases, removal of the greater omentum and retroperitoneal lymph nodes is feasible, preserving the uterus and contralateral ovaries. In contrast, menopausal women should have the uterus and both adnexa removed. Postoperative chemotherapy is not necessary for stage IA asexual cell tumors. Timely chemotherapy after surgery for advanced malignant germ cell tumors is very important. VBP, BEP, VAC regimen should be performed for 4-6 courses and serum tumor marker levels should be monitored.
(6) Interstitial tumors of the sex cords: Interstitial tumors of the sex cords account for 5% to 8% of all ovarian malignant tumors. Therefore, the diagnosis of each interstitial tumor is not based on the clinical endocrine function and the specific hormones secreted by the tumor, but is determined solely by the pathological pattern of the tumor. Most interstitial tumors of the sex cords (e.g., fibrous tumors, follicular meningiomas, supportive cell tumors, sclerosing mesenchymal tumors, etc.) are benign and should be treated as such. Some low-grade or potentially malignant ones (e.g., granulosa cell tumor, mesenchymal cell tumor, cyclic tubular sex cord mesenchymal tumor, etc.) are treated as follows.
① ⅠA young patients: unilateral adnexal resection or dissection to determine the stage is feasible.
②Women who have completed childbirth in stage ⅠA and ⅠB undergo stage-determining dissection.
③Stage ⅠC, Ⅱ, Ⅲ and Ⅳ patients undergo tumor cytoreductive surgery and postoperative chemotherapy with PAC, BEP or VBP regimen for 6 courses.
④Late recurrence: this type of tumor has the characteristics of late recurrence (such as granulosa cell tumor) should be followed up for a long time, and recurrent or metastatic tumor should be resected again.
2.Treatment of recurrence
Although ovarian cancer has a clinical efficiency of 60% to 80% with platinum-based chemotherapy after initial tumor cell reduction, eventually most patients relapse. The current treatment of recurrent patients is difficult and salvage measures are not curative. Therefore, the aim of treatment should be to improve the quality of life.
(1) Again cytoreductive surgery is only effective in a few cases with mild recurrence, and most of them can only relieve symptoms (such as relieving intestinal obstruction), making it difficult to improve survival. However, recurrence of malignant germ cell tumors, sex cord mesenchymal tumors and junctional tumors should be aggressively resected surgically again.
(2) For patients who have relapsed with cisplatin chemotherapy, etoposide (pediposide), paclitaxel (Taxol), mitoxantrone (Mitoxantrone), isocyclic amide (IFO) and tolbuterol (TPT) can be tried, and their efficiency rates are about 36%, 22%, 14%, 12% and 14%, respectively. Patients who have been effectively treated with cisplatin chemotherapy and have a tumor-free interval (effective remission period) of more than six months can repeat platinum-based chemotherapy.
(3) Due to the severe response to chemotherapy, the patient’s quality of life should be considered and the patient’s choice should be respected. For example, in relapsed patients with severe ascites, abdominal chemistry with fewer side effects is available to improve symptoms.
(4) Do not give high-dose chemotherapy to patients with impaired liver and kidney function and without bone marrow metastasis (ABMT) or peripheral blood stem cell transplantation (PB-SCT) technical conditions.
(5) Certain recurrent tumors of germ cell tumors and interstitial tumors of the sex cords that are more sensitive to radiotherapy can be treated with radiotherapy after re-excision, and radiotherapy for certain locally recurrent epithelial tumors can relieve local symptoms.
3.Follow up and monitoring
(1) Disease monitoring: Ovarian malignant tumor is a kind of chemotherapy-sensitive but easily recurring tumor, which should be followed up and monitored for a long time. The contents of follow-up and monitoring are as follows.
(1) Clinical symptoms, signs, general and pelvic examinations.
②Imaging examination: ultrasound, CT, MRI (if available).
③Radioimmunoimaging (if available).
④Tumor markers: CA125, AFP, HCG, CEA.
⑤ Steroid hormone measurement: estrogen, progesterone and androgen (certain sex cord mesenchymal tumors)
⑥Second-look surgery (as previously described)
(7) Postoperative follow-up: 1 year postoperatively, once a month; 2 years postoperatively, once every 3 months; 3 years postoperatively, once every 6 months; more than 3 years, once a year.
(2) Efficacy evaluation.
①Recurrence criteria.
A. Pelvic and abdominal cavity examination: tumor or ascites was found.
B. Chest examination: finding pleural effusion (cytology find tumor cells) or lung shadow.
C. Lymph node metastasis: supraclavicular or inguinal lymph nodes.
D. Imaging: positive findings on X-ray, CT, MRI, ultrasound or nuclear imaging.
E. Recurrent lesions were found by second exploration and pathologically confirmed to be positive for tumor cells in the abdominal washout fluid.
②Scoring criteria.
A. The tumor was removed at the time of surgery, and there were no more clinical observation indicators.
Remission: no recurrence according to the above criteria.
Recurrence: according to any one of the above criteria.
B. The mass was not excised at the time of surgery, and there are still clinical observation indicators.
Complete remission (CR): complete disappearance of tumor for more than 3 months.
Partial remission (PR): tumor shrinkage ≥ 50% for more than 3 months.
(II) Prognosis
Malignant tumors of pediatric ovaries, such as malignant teratoma and anaplastic cell tumor, have a better prognosis if they are detected early, removed before local and distant spread, and treated with radiotherapy and chemotherapy. Embryonal carcinoma has the worst prognosis.