[Oncological and reproductive outcomes in patients with malignant transformation of ovarian mature cystic teratoma].

Abstract

Objective: To investigate the oncological outcomes of patients with malignant transformation of ovarian mature cystic teratoma (OMCT) and the reproductive outcomes of young patients undergoing fertility sparing surgery (FSS). Methods: Clinicopathological data of 39 patients with malignant transformation of OMCT enrolled at the First Affiliated Hospital of Zhengzhou University from August 2011 to December 2024 were retrospectively collected. Their oncological outcomes were analyzed. Univariate and multivariate Cox proportional hazards regression models were used to identify factors associated with disease free survival (DFS) and overall survival (OS). Reproductive outcomes were analyzed in patients under 45 years old who underwent FSS. Furthermore, the clinicopathological data and oncological outcomes of 8 concurrently enrolled patients of OMCT with carcinoid tumor were analyzed and compared. Results: (1) The mean age of patients with malignant transformation of OMCT was (52.7±14.0) years, and the mean maximum tumor diameter was (10.8±0.8) cm. Surgical treatment was performed in all patients, intraoperative tumor rupture occurred in 8 patients (21%, 8/39). The pathological types included squamous cell carcinoma in 29 cases (74%, 29/39), mucinous adenocarcinoma in 9 cases (23%, 9/39), and malignant melanoma in 1 case (3%, 1/39).27 patients (69%, 27/39) were classified as stage Ⅰ, 4 patients (10%, 4/39) as stage Ⅱ, and 8 patients (21%, 8/39) as stage Ⅲ. (2) The median follow-up duration for these patients was 86.0 months. During follow-up, recurrence was observed in 12 patients (31%, 12/39), all of whom died. In addition, one patient died of non-cancer causes. At the last follow-up, 13 patients (33%, 13/39) died; while the remaining patients were alive with no evidence of disease. The 5-year disease free survival (DFS) and overall survival (OS) rates were 67% and 65%, respectively. Cox regression analysis identified a maximum tumor diameter≥13 cm, stageⅡ-Ⅲ and intraoperative tumor rupture as independent risk factors for both DFS and OS (all P<0.05). (3) Among the 5 patients under 45 years old with malignant transformation of OMCT who underwent FSS, 4 were staged as Ⅰa and 1 as Ⅱ. Three of the patients with Ⅰa stage successfully conceived naturally and delivered at full term within 1-2 years after surgery. The patient with stage Ⅱ died due to disease progression, while the remaining 4 patients were alive with no evidence of disease.(4) The mean age of the 8 patients of OMCT with carcinoid tumor was (42.4±18.0) years, the mean maximum tumor diameter was (15.0±9.1) cm. No recurrence was observed during follow-up, and all patients were alive with no evidence of disease at the last follow-up date on May 30, 2025. Survival analysis indicated no statistically significant difference in OS between patients with malignant transformation of OMCT and those of OMCT with carcinoid tumors (P=0.102). Conclusions: The maximum tumor diameter≥13 cm, intraoperative tumor rupture and stage Ⅱ-Ⅲ are unfavorable prognostic factors for patients with malignant transformation of OMCT. FSS may be a viable option for young patients with stage Ⅰa malignant transformation of OMCT who wish to preserve their fertility, close postoperative follow-up is required.