Malignant ovarian germ cell tumors: clinico-pathological presentation and survival outcomes

Abstract

Objective: To evaluate clinico-pathological features, treatment, survival, and prognostic factors of patients with malignant ovarian germ cell tumors.

Design: Descriptive study.

Setting: Bangkok Metropolitan Administration Medical College and Vajira Hospital and Prince of Songkla University.

Population: Malignant ovarian germ cell tumor patients treated between January 1996 and December 2007.

Methods: Clinico-pathological data were collected. Patients with malignant tumors arising from benign cystic teratoma were excluded. Survival and potential prognostic factors were analyzed.

Main outcome measures: Clinico-pathological features, survival.

Results: One hundred and thirty patients were identified. The median age was 21 years (range, 4-44 years). The most common complaint was pelvic or abdominal mass (63%). Primary surgery was performed by a gynecologic oncologist in only 39.2% of cases. More than half (64.2%) had early stage disease (stages I-II) and the majority had conservative surgery (73.1%). The most common histopathology was dysgerminoma. Of 124 patients with available follow-up data, 22 did not receive adjuvant treatment; 1 had whole abdominal radiation; and 101 had chemotherapy. Of 89 patients who were evaluable for responses, 4 patients had progressive disease while 85 had complete response. The five-year progression-free survival (PFS) and overall survival (OS) were 82.4% [95% confidence interval (CI), 75.4-89.5%)] and 92.4% (95% CI, 87.6-97.2%), respectively. Only preoperative tumor marker elevation was a significant poor prognostic factor for PFS.

Conclusions: Malignant ovarian germ cell tumors have a good prognosis with conservative surgical treatment. Chemotherapy is important. Elevated preoperative serum tumor markers are a poor prognostic factor for PFS.