Comprehensive staging allows for excellent outcome in patients with localized malignant germ cell tumor of the ovary

Abstract

Background: The management of malignant germ cell tumors of the ovary (OMGCT) requires multidisciplinary expertise. We analyze the surgical and medical outcomes of a cohort of patients treated for OMGCT.

Patients and methods: Data concerning diagnosis, surgery, and medical decisions were reviewed for all patients seen for postoperative management of OMGCT at the Centre Léon Bérard in Lyon and the Institut Curie in Paris between 1985 and 2003. Sixty patients aged 0.4 to 27.9 years (mean 12.8 years) at diagnosis were included.

Results: Twenty (53%) of 38 the International Federation of Gynecology and Obstetrics (FIGO) stage I tumors were staged Ix. All stage Ix tumors had been operated by a nongynecologic surgeon. Relapses occurred in 8 of 24 stage I tumors that were observed (0/8 stage Ia; 5/13 stage Ix (P = 0.044) and 3/3 stage Ic) versus 0/14 stage I treated by adjuvant chemotherapy (P = 0.0015). The risk of relapse was significantly increased if patients underwent postsurgical observation ((HR) = 4.5 (95% CI, 1.5 to 13.3)), and when the tumor contained yolk sac tumor (HR = 7.3 (95% CI, 2.3 to 22.7)). There was no significant prognostic value for age, stage, level of tumor markers at diagnosis, type of surgery, and type of chemotherapy. Five-year overall survival was 96.7%, and event free survival was 83.3%.

Conclusion: Comprehensive staging after removal of localized OMGCT is crucial. It allows a safe observation strategy in stage Ia tumors. Patients with stages Ix and Ic tumors may benefit from adjuvant chemotherapy.