A retrospective analysis of the pattern of care and survival in patients with malignant ovarian germ cell tumors

Abstract Objective: The objective of this study is to evaluate the pattern of care and survival outcome in patients with malignant ovarian germ cell tumors (MOGCTs). Materials and Methods: Between January 2004 and August 2017, 50 patients with MOGCT were identified at Amrita Institute of Medical Sciences and 48 included in analyses. Histologic subtypes were as follows: dysgerminoma 11; immature teratoma 16; yolk sac tumor 3; and mixed germ cell tumor 18. 31 (64.6% patients belonged to Stage I and 17 (35.4%) patients were advanced stage (Stage II-IV). Results: Median follow-up period was 34 months (range: 1–241 months). The 5- and 10-year disease-free survival (DFS) and overall survival (OS) for the entire cohort were 87.5% and 94.4%, respectively. DFS and OS of incomplete surgery Stage I patients 28.6% and 68.6%, respectively, were significantly lower than completely staged patients 100%. Out of 8 incomplete surgery patients, 5 recurred of which 2 died of disease within 4 and 9 months of recurrence. There was no survival difference with comprehensive surgical staging (CSS) and pediatric surgical staging (PSS) in Stage I MOGCT (DFS and OS 100%). Stage I dysgerminoma kept on active surveillance after PSS had equivalent survival of 100%. There was no survival difference in advanced stage MOGCT treated with primary debulking surgery and neoadjuvant chemotherapy (NAC) followed by fertility-sparing surgery (DFS and OS 100%). Conclusion: Incomplete surgery in Stage I MOGCT was associated with poor survival. There was no survival difference with CSS and PSS. NAC followed by surgery could be a reasonable option for patients of advanced stage MOGCT.

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Significance of the Complete Surgical Staging of Stage I Malignant Ovarian Germ Cell Tumors

Annals of Surgical Oncology ◽

10.1245/s10434-016-5234-z ◽

2016 ◽

Vol 23 (9) ◽

pp. 2982-2987 ◽

Cited By ~ 6

Author(s):

Jeong-Yeol Park ◽

Dae-Yeon Kim ◽

Dae-Shik Suh ◽

Jong-Hyeok Kim ◽

Yong-Man Kim ◽

...

Keyword(s):

Germ Cell ◽

Germ Cell Tumors ◽

Stage I ◽

Surgical Staging

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Management of Ovarian Germ Cell Tumors

Journal of Clinical Oncology ◽

10.1200/jco.2007.10.8738 ◽

2007 ◽

Vol 25 (20) ◽

pp. 2938-2943 ◽

Cited By ~ 167

Author(s):

David M. Gershenson

Keyword(s):

Prognostic Factors ◽

Germ Cell ◽

Germ Cell Tumors ◽

Reproductive Function ◽

Advanced Stage ◽

Early Stage Disease ◽

Fertility Sparing Surgery ◽

Stage Disease ◽

Fertility Sparing ◽

Cure Rates

Purpose To review contemporary management of malignant ovarian germ cell tumors (MOGCT). Design The literature on the topic of MOGCT is reviewed, including pathology, prognostic factors, surgical strategies, postoperative therapy, late effects of therapy, and treatment of recurrence. Results Prognostic factors for MOGCT include the International Federation of Gynecology and Obstetrics staging system's stage, residual disease, histologic type, and elevation of serum tumor markers. Fertility-sparing surgery is possible in a large proportion of patients. The importance of comprehensive surgical staging is somewhat controversial. For patients with advanced-stage disease, maximum cytoreductive surgery appears to be beneficial. Although second-look surgery is not recommended routinely, selected patients may benefit from secondary cytoreduction. For those patients who require postoperative chemotherapy, standard therapy consists of the combination of bleomycin, etoposide, and cisplatin. However, there is a growing trend toward surveillance; this strategy continues to be studied. Although premature menopause may occur in a small proportion of patients, at least 80% of those who undergo fertility-sparing surgery and chemotherapy may expect to preserve reproductive function. For patients with early-stage disease, cure rates approach 100%. For those with advanced-stage disease, cure rates are reportedly at least 75%. Conclusion MOGCT is a rare malignancy that principally affects girls and young women. With optimal therapy, the prognosis is excellent, and most patients may retain reproductive function.

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Outcomes of Surgery Alone and Surveillance Strategy in Young Women With Stage I Malignant Ovarian Germ Cell Tumors

International Journal of Gynecological Cancer ◽

10.1097/igc.0000000000000702 ◽

2016 ◽

Vol 26 (5) ◽

pp. 859-864 ◽

Cited By ~ 15

Author(s):

Jeong-Yeol Park ◽

Dae-Yeon Kim ◽

Dae-Shik Suh ◽

Jong-Hyeok Kim ◽

Yong-Man Kim ◽

...

Keyword(s):

Overall Survival ◽

Survival Rate ◽

Germ Cell ◽

Young Women ◽

Disease Free Survival ◽

Stage I ◽

Fertility Sparing Surgery ◽

Fertility Sparing ◽

Bep Chemotherapy

ObjectivesThis study aimed to evaluate the safety of surgery alone followed by surveillance in young women with stage I malignant ovarian germ cell tumor (MOGCT).MethodsA retrospective review was performed on 31 patients with stage I MOGCT who were treated by surgery alone with follow-up.ResultsThe median patient age was 22 years (range, 6–45 years). The histological type was dysgerminoma in 17, immature teratoma in 11, yolk sac tumor in 1, and mixed MOGCT in 2 cases. Seventeen patients were stage IA, 1 was IB, and 13 were IC. All patients underwent fertility-sparing surgery, which involved either unilateral salpingo-oophorectomy or oophorectomy. Additionally, 12 (38.7%) patients underwent cystectomy of the contralateral ovary, but only 1 patient had MOGCT in the contralateral ovary. Twenty (65%) patients underwent a complete staging operation that included peritoneal exploration, biopsy, cytology, and/or omentectomy or omental biopsy; 7 (22.6%) patients who underwent pelvic and para-aortic lymphadenectomy. After a median follow-up time of 137 months (range, 24–268 months), 7 (22.6%) patients had recurrent disease, and underwent secondary surgery followed by chemotherapy with bleomycin, etoposide, and cisplatin (BEP). Six (86%) patients were successfully salvaged, but 1 died of disease progression. The 10-year disease-free survival rate was 77%, but the 10-year overall survival rate was 97%.ConclusionsFertility-sparing surgery alone with surveillance could be a safe treatment strategy. Most recurrence can be successfully salvaged by surgery and BEP chemotherapy and the overall survival is not compromised. Using this strategy, 77.4% of patients may avoid unnecessary BEP chemotherapy.

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

Japanese Journal of Clinical Oncology ◽

10.1093/jjco/hyz180 ◽

2019 ◽

Vol 50 (3) ◽

pp. 282-287 ◽

Cited By ~ 2

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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