scholarly journals Is Omentectomy Mandatory Among Early Stage (I, II) Malignant Ovarian Germ Cell Tumor Patients? A Retrospective Study of 223 Cases

2017 ◽  
Vol 27 (7) ◽  
pp. 1373-1378 ◽  
Author(s):  
Wenyan Xu ◽  
Yanfang Li
Keyword(s):  
Germ Cell ◽  
Early Stage ◽  
Survival Rates ◽  
Germ Cell Tumors ◽  
Stage I ◽  
Stage Ii ◽  
Histological Subtypes ◽  
Histologic Subtype ◽  
Gynecology And Obstetrics ◽  
Initial Surgery

ObjectiveThe aim of the study was to investigate whether omentectomy (OMT) is necessary in the operation for apparently early stage malignant ovarian germ cell tumors (MOGCTs).Methods and MaterialsSearching medical records database of Sun Yat-sen University Cancer Center from January 1, 1966, to November 30, 2015, patients with MOGCTs were identified and their age, year of diagnosis, tumor grade, histologic subtype, International Federation of Gynecology and Obstetrics stage, nodal findings, gross observation of omentum, and performance of OMT were assessed. Overall survivals of patients with or without OMT were compared using Kaplan-Meier survival curves.ResultsA total of 223 MOGCT cases with clinically early stage (stage I and II) disease and with the 3 common histological subtypes of MOGCT were obtained, which include yolk sac tumor (YST), dysgerminoma (DSG), and immature teratoma (IMT). There were 192 stage I cases and 31 stage II cases. Fifty-four patients were diagnosed with YST, 61 with DSG, and 108 with IMT. Omentectomy was performed as part of the initial surgery in 74.0% patients (165/223) and was omitted in 26.0% patients (58/223). Chemotherapy was administered in 88.3% (197/223) of all patients. The median follow-up was 82.0 months. The 10-year overall survival rates of the patients with and without OMT were 90.5% and 98.1%, respectively (P = 0.156). Regarding different stages or histological subtypes, the 10-year survival rates of the 2 groups were 92.0% versus 97.9% (P = 0.324, stage I), 83.2% versus 100% (P = 0.351, stage II), 89.2% versus 100% (P = 0.303, YST), 94.1% versus 100% (P = 0.470, DSG), and 89.4% versus 96.0% (P = 0.405, IMT), respectively.ConclusionsIn conclusion, OMT in patients with clinically early stage MOGCT may not improve patient survival and may be omitted.

Treatment of malignant germ cell tumors of the ovary with bleomycin, etoposide, and cisplatin.

1990 ◽  
Vol 8 (4) ◽  
pp. 715-720 ◽  
Author(s):  
D M Gershenson ◽  
M Morris ◽  
A Cangir ◽  
J J Kavanagh ◽  
C A Stringer ◽  
...  
Keyword(s):  
Germ Cell ◽  
Residual Disease ◽  
Germ Cell Tumors ◽  
Complete Response ◽  
Stage I ◽  
Stage Ii ◽  
Stage Iii ◽  
Cancer Center ◽  
Sustained Remission ◽  
Initial Surgery

Since 1984, we have treated 26 patients with malignant ovarian germ cell tumors with a combination of bleomycin, etoposide (VP-16), and cisplatin (BEP) at The University of Texas MD Anderson Cancer Center (UTMDACC). The median age of the patients was 19 years (range, 8 to 32). All patients underwent initial surgery (unilateral salpingo-oophorectomy in 14, unilateral salpingo-oophorectomy plus abdominal hysterectomy in one, and bilateral salpingo-oophorectomy with or without hysterectomy in 11 patients). Twenty patients had no residual disease, three had less than or equal to 2 cm (one each, dysgerminoma, mixed, and immature teratoma), and three had more than 2 cm lesions (two dysgerminomas, one endodermal sinus tumor). Fourteen patients had pure dysgerminoma (five, stage I; one, stage II; six, stage III; and two, recurrent), and 12 had nondysgerminomatous tumors (five, stage I; two, stage II; three, stage III; and two, recurrent). All four patients with clinically measurable disease had a complete response. All four patients who underwent second-look laparotomy had negative findings. Twenty-five patients (96%) remain in sustained remission 10.4 to 54.4 months from the start of chemotherapy. One patient died of progressive disease 14 months after beginning chemotherapy. We conclude that the BEP regimen has excellent activity and acceptable toxicity in patients with malignant ovarian germ cell tumors.

scholarly journals Reduced and Compressed Cisplatin-Based Chemotherapy in Children and Adolescents With Intermediate-Risk Extracranial Malignant Germ Cell Tumors: A Report From the Children’s Oncology Group

2017 ◽  
Vol 35 (11) ◽  
pp. 1203-1210 ◽  
Author(s):  
Furqan Shaikh ◽  
John W. Cullen ◽  
Thomas A. Olson ◽  
Farzana Pashankar ◽  
Marcio H. Malogolowkin ◽  
...  
Keyword(s):  
Germ Cell ◽  
Children And Adolescents ◽  
Statistical Significance ◽  
Germ Cell Tumors ◽  
Stage I ◽  
Stage Ii ◽  
Intermediate Risk ◽  
Historical Cohort ◽  
Number Of Cycles ◽  
Malignant Germ Cell Tumors

Purpose To investigate whether event-free survival (EFS) can be maintained among children and adolescents with intermediate-risk (IR) malignant germ cell tumors (MGCT) if the administration of cisplatin, etoposide, and bleomycin (PEb) is reduced from four to three cycles and compressed from 5 to 3 days per cycle. Patients and Methods In a phase 3, single-arm trial, patients with IR MGCT (stage II-IV testicular, II-III ovarian, I-II extragonadal, or stage I gonadal tumors with subsequent recurrence) received three cycles of PEb. A parametric comparator model specified that the observed EFS rate should not be significantly < 92%. As recommended for trials that test a reduction of therapy, a one-sided P value ≤ .10 was used to indicate statistical significance. In a post hoc analysis, we also compared results to the EFS rate of comparable patients treated with four cycles of PEb in two prior studies. Results Among 210 eligible patients enrolled from 2003 to 2011, 4-year EFS (EFS4) rate was 89% (95% confidence interval, 83% to 92%), which was significantly lower than the 92% threshold of the comparison model ( P = .08). Among 181 newly diagnosed patients, the EFS4 rate was 87%, compared with 92% for 92 comparable children in the historical cohort ( P = .15). The EFS4 rate was significantly associated with stage (stage I, 100%; stage II, 92%; stage III, 85%; and stage IV, 54%; P < .001). Conclusion The EFS rate for children with IR MGCT observed after three cycles of PEb was less than that of a prespecified parametric model, particularly for patients with higher-stage tumors. These data do not support a reduction in the number of cycles of PEb from four to three. However, further investigation of a reduction in the number of cycles for patients with lower-stage tumors is warranted.

scholarly journals Are omentectomy and lymphadenectomy necessary in patients with apparently early-stage malignant ovarian germ cell tumors?

2019 ◽  
Vol 29 (2) ◽  
pp. 398-403 ◽  
Author(s):  
Beijiao Qin ◽  
Wenyan Xu ◽  
Yanfang Li
Keyword(s):  
Prognostic Factors ◽  
Germ Cell ◽  
Early Stage ◽  
Survival Rates ◽  
Germ Cell Tumors ◽  
Yolk Sac ◽  
Immature Teratoma ◽  
Yolk Sac Tumor ◽  
Cancer Center ◽  
Early Stage Disease

ObjectiveTo evaluate the role of omentectomy and lymphadenectomy in the treatment of clinically apparent early-stage malignant ovarian germ cell tumors.MethodsWe retrospectively reviewed 245 patients with malignant ovarian germ cell tumors (yolk sac tumor, dysgerminoma, and immature teratoma) and with clinically early-stage disease, who were treated at Sun Yat-sen University Cancer Center between January 1, 1970 and December 31, 2017. The survival of patients who underwent either omentectomy or lymphadenectomy, or both (omentectomy/lymphadenectomy group) was compared with that of patients who did not undergo omentectomy or lymphadenectomy (non-omentectomy/lymphadenectomy group).ResultsSixty patients were diagnosed with yolk sac tumor, 74 with dysgerminoma, and 111 with immature teratoma. Of these 245 patients, 216 patients had stage I disease, 28 patients had stage II, and 1 patient had stage IIIA. There were 190 patients who underwent omentectomy and/or lymphadenectomy and 55 patients in the non-omentectomy/lymphadenectomy group, respectively. In the omentectomy/lymphadenectomy group, 112 patients underwent both omentectomy and lymphadenectomy, 71 underwent omentectomy only, and 7 underwent lymphadenectomy only. Two hundred and fourteen of 245 patients (87.3%) received post-operative chemotherapy. Median follow-up was 73 months (range 1–388). The 10-year overall survival rates in the omentectomy/lymphadenectomy group and non-omentectomy/lymphadenectomy groups were 96.8% and 100%, respectively (p=0.340). Multivariate analysis evaluating all potential prognostic factors showed that omentectomy and lymphadenectomy are not prognostic factors for survival.ConclusionsOmentectomy and lymphadenectomy do not appear to improve survival and may be omitted in patients with clinically apparent early-stage malignant ovarian germ cell tumors.

Surveillance after initial surgery for Stage I pediatric and adolescent boys with malignant testicular germ cell tumors: Report from the Children’s Oncology Group

2015 ◽  
Vol 50 (6) ◽  
pp. 1000-1003 ◽  
Author(s):  
Frederick J. Rescorla ◽  
Jonathan H. Ross ◽  
Deborah F. Billmire ◽  
Bryan J. Dicken ◽  
Doojduen Villaluna ◽  
...  
Keyword(s):  
Germ Cell ◽  
Germ Cell Tumors ◽  
Stage I ◽  
Testicular Germ Cell Tumors ◽  
Oncology Group ◽  
Adolescent Boys ◽  
Testicular Germ Cell ◽  
Initial Surgery

Treatment of Children and Adolescents With Stage II Testicular and Stages I and II Ovarian Malignant Germ Cell Tumors: A Pediatric Intergroup Study—Pediatric Oncology Group 9048 and Children's Cancer Group 8891

2004 ◽  
Vol 22 (17) ◽  
pp. 3563-3569 ◽  
Author(s):  
Paul C. Rogers ◽  
Thomas A. Olson ◽  
John W. Cullen ◽  
Deborah F. Billmire ◽  
Neyssa Marina ◽  
...  
Keyword(s):  
Germ Cell ◽  
Pediatric Oncology ◽  
Germ Cell Tumors ◽  
Stage I ◽  
Stage Ii ◽  
Oncology Group ◽  
Cancer Group ◽  
Pediatric Oncology Group ◽  
Grade 3 ◽  
Malignant Germ Cell Tumors

Purpose To determine whether children with localized gonadal malignant germ cell tumors (MGCT) stage II testicular and stages I and II ovarian treated with four cycles of standard-dose cisplatin combined with etoposide and low-dose bleomycin (PEB) have an event-free survival (EFS) of at least 85% without significant toxicity. Patients and Methods Between May 1990 and July 1995, eligible pediatric patients with stage II or recurrent from stage I (as a stage II) testicular MGCT and stages I and II ovarian MGCT were enrolled onto this Pediatric Oncology Group and Children's Cancer Group study. PEB chemotherapy consisted of bleomycin 15 U/m2 on day 1, cisplatin 20 mg/m2/d on days 1 to 5, and etoposide 100 mg/m2/d on days 1 to 5. Patients received four cycles of therapy at 21-day intervals. Results Seventy-four patients with a median age of 10.5 years (range, 8.7 months to 16.7 years) were enrolled. Primary sites included: stage II testicular (n = 17), stage I ovarian (n = 41), and stage II ovarian MGCT (n = 16). Treatment with standard PEB resulted in 6-year EFS of 95% and overall survival (OS) of 95.7%. EFS and OS by primary site were as follows: stage II testicular, 100% and 100%; stage I ovarian, 95.1% and 95.1%; and stage II ovarian, 87.5% and 93.8%, respectively. Two patients died from recurrent disease, and one patient died of secondary acute myelocytic leukemia. Infrequent grade 3 to 4 hematologic toxicity was reported. No grade 3 to 4 renal, pulmonary, or ototoxicity was observed. Conclusion Combination chemotherapy with PEB results in excellent EFS and OS with minimal toxicity in children and adolescents with localized gonadal MGCT.

Gene Expression Signature to Improve Prognosis Prediction of Stage II and III Colorectal Cancer

2011 ◽  
Vol 29 (1) ◽  
pp. 17-24 ◽  
Author(s):  
Ramon Salazar ◽  
Paul Roepman ◽  
Gabriel Capella ◽  
Victor Moreno ◽  
Iris Simon ◽  
...  
Keyword(s):  
Gene Expression ◽  
Colorectal Cancer ◽  
High Risk ◽  
Early Stage ◽  
Survival Rates ◽  
Gene Expression Signature ◽  
Stage I ◽  
Stage Ii ◽  
Free Survival ◽  
Risk Of Cancer

Purpose This study aims to develop a robust gene expression classifier that can predict disease relapse in patients with early-stage colorectal cancer (CRC). Patients and Methods Fresh frozen tumor tissue from 188 patients with stage I to IV CRC undergoing surgery was analyzed using Agilent 44K oligonucleotide arrays. Median follow-up time was 65.1 months, and the majority of patients (83.6%) did not receive adjuvant chemotherapy. A nearest mean classifier was developed using a cross-validation procedure to score all genes for their association with 5-year distant metastasis–free survival. Results An optimal set of 18 genes was identified and used to construct a prognostic classifier (ColoPrint). The signature was validated on an independent set of 206 samples from patients with stage I, II, and III CRC. The signature classified 60% of patients as low risk and 40% as high risk. Five-year relapse-free survival rates were 87.6% (95% CI, 81.5% to 93.7%) and 67.2% (95% CI, 55.4% to 79.0%) for low- and high-risk patients, respectively, with a hazard ratio (HR) of 2.5 (95% CI, 1.33 to 4.73; P = .005). In multivariate analysis, the signature remained one of the most significant prognostic factors, with an HR of 2.69 (95% CI, 1.41 to 5.14; P = .003). In patients with stage II CRC, the signature had an HR of 3.34 (P = .017) and was superior to American Society of Clinical Oncology criteria in assessing the risk of cancer recurrence without prescreening for microsatellite instability (MSI). Conclusion ColoPrint significantly improves the prognostic accuracy of pathologic factors and MSI in patients with stage II and III CRC and facilitates the identification of patients with stage II disease who may be safely managed without chemotherapy.

scholarly journals Surveillance After Initial Surgery for Pediatric and Adolescent Girls With Stage I Ovarian Germ Cell Tumors: Report From the Children's Oncology Group

2014 ◽  
Vol 32 (5) ◽  
pp. 465-470 ◽  
Author(s):  
Deborah F. Billmire ◽  
John W. Cullen ◽  
Frederick J. Rescorla ◽  
Mary Davis ◽  
Marc G. Schlatter ◽  
...  
Keyword(s):  
Germ Cell ◽  
Recurrent Disease ◽  
Germ Cell Tumors ◽  
Salvage Chemotherapy ◽  
Yolk Sac ◽  
Stage I ◽  
Oncology Group ◽  
Time To Recurrence ◽  
Kaplan Meier ◽  
Initial Surgery

Purpose To determine whether overall survival (OS) can be preserved for patients with stage I pediatric malignant ovarian germ cell tumor (MOGCT) with an initial strategy of surveillance after surgical resection. Patients and Methods Between November 2003 and July 2011, girls age 0 to 16 years with stage I MOGCT were enrolled onto Children's Oncology Group study AGCT0132. Required histology included yolk sac, embryonal carcinoma, or choriocarcinoma. Surveillance included measurement of serum tumor markers and radiologic imaging at defined intervals. In those with residual or recurrent disease, chemotherapy with compressed PEB (cisplatin, etoposide, and bleomycin) was initiated every 3 weeks for three cycles (cisplatin 33 mg/m2 on days 1 to 3, etoposide 167 mg/m2 on days 1 to 3, bleomycin 15 U/m2 on day 1). Survivor functions for event-free survival (EFS) and OS were estimated using the Kaplan-Meier method. Results Twenty-five girls (median age, 12 years) with stage I MOGCT were enrolled onto AGCT0132. Twenty-three patients had elevated alpha-fetoprotein (AFP) at diagnosis. Predominant histology was yolk sac. After a median follow-up of 42 months, 12 patients had evidence of persistent or recurrent disease (4-year EFS, 52%; 95% CI, 31% to 69%). Median time to recurrence was 2 months. All patients had elevated AFP at recurrence; six had localized disease, two had metastatic disease, and four had tumor marker elevation only. Eleven of 12 patients experiencing relapse received successful salvage chemotherapy (4-year OS, 96%; 95% CI, 74% to 99%). Conclusion Fifty percent of patients with stage I pediatric MOGCT can be spared chemotherapy; treatment for those who experience recurrence preserves OS. Further study is needed to identify the factors that predict recurrence and whether this strategy can be extended successfully to older adolescents and young adults.

scholarly journals The impact of lymphadenectomy on prognosis and survival of clinically apparent early-stage malignant ovarian germ cell tumors

2019 ◽  
Vol 50 (3) ◽  
pp. 282-287 ◽  
Author(s):  
Beijiao Qin ◽  
Wenyan Xu ◽  
Yanfang Li
Keyword(s):  
Survival Rate ◽  
Germ Cell ◽  
Early Stage ◽  
Clinical Stage ◽  
Germ Cell Tumors ◽  
Disease Free Survival ◽  
Stage I ◽  
Cancer Center ◽  
Improve Patient Survival ◽  
The Impact

Abstract Objective To determine the impact of lymphadenectomy (LND) on survival of clinically apparent early-stage malignant ovarian germ cell tumors (MOGCTs). Methods We retrospectively analyzed the survival of patients who were diagnosed with the three most common histopathology types of malignant ovarian germ cell tumors (yolk sac tumor, dysgerminoma and immature teratoma) and with clinical stage I and II disease, and treated at Sun Yat-sen University Cancer Center between 1 January 1970 and 30 September 2018. Results There were 227 stage I, 28 stage II and one stage IIIA cases after surgery. One hundred and twenty-six patients underwent lymphadenectomy and 130 did not. Only one lymph node metastasis (0.8%) was found in the lymphadenectomy group. Two hundred and twenty-four out of 256 patients (87.5%) received postoperative chemotherapy. There were five relapses (4.0%) in the lymphadenectomy group and four (3.1%) in the non-lymphadenectomy group. Median follow-up was 68 months (range, 1–388). The 10-year disease-free survival rate in the lymphadenectomy group and non-lymphadenectomy group were 88.2 and 96.4%, respectively (P = 0.412); the 10-year overall survival rate in the two groups were 95.7 and 98.2%; respectively (P = 0.798). The results showed that lymphadenectomy did not improve patient survival. Conclusions Lymphadenectomy may have little impact on survival in patients with clinically apparent early-stage malignant ovarian germ cell tumors and may be omitted in the surgical treatment.

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