Surveillance an Option for Early-Stage Ovarian Germ Cell Tumors

The use of surveillance did not affect survival among women with stage I malignant ovarian germ cell tumors (MOGCTs), according to a new retrospective analysis. Yolk sac histology offers a worse prognosis than other types of tumor.

MOGCTs are rare ovarian tumors, accounting for up to 5% of all ovarian malignancies. “Due to their rarity, relatively few studies have focused on female [germ cell tumor] patients, whose treatment is therefore mainly mutuated from guidelines for management of male [germ cell tumors] and epithelial ovarian cancer,” wrote study authors led by Cristina Sigismondi, MD, of IRCCS San Raffaele Hospital in Milan, Italy.

Standard care consists of fertility-sparing surgery with surgical staging, following by platinum-based chemotherapy; the exceptions to this are stage IA dysgerminoma, and stage IA immature teratoma, for which surgery alone can be curative. Given the lack of research in this malignancy and questions regarding surveillance and the importance of staging, the researchers analyzed outcomes from 144 patients with stage I MOGCTs among several Italian centers. The results were published online ahead of print in Annals of Oncology.

Of the total cohort, 55 patients (38.2%) had dysgerminomas, 49 (34%) had immature teratoma, 26 (18.1%) had yolk sac tumors, and 14 patients (9.7%) had mixed tumors that included a component of yolk sac tumor. The mean age at diagnosis was 27.5 years.

All patients underwent surgery, and most (86.8%) underwent fertility-sparing surgery. Complete peritoneal surgical stating was done in 94 patients (65.3%). A total of 73 patients (50.7%) received adjuvant chemotherapy, and 71 (49.3%) received surgery alone.

Disease recurrence occurred in 23 patients (16%), and incomplete surgical staging was significantly associated with the risk of recurrence (odds ratio, 2.37; 95% CI, 1.04–5.44; P = .04). The 5-year overall survival rate was 83.7% in patients with yolk sac or mixed tumors, compared with 98.6% in those with other histologies (P < .05). Surgical staging did not, however, significantly affect prognosis; the 5-year overall survival rate was 96.8% in those completely surgically staged vs 88.7% with incomplete staging, the difference was not statistically significant.

The 5-year overall survival rate was also no different when surveillance was used. Surveillance patients had a 5-year overall survival rate of 94.1%, compared with 93.8% for other patients.

“Our study shows that surveillance should be performed in stage I dysgerminoma and immature teratoma tumors with correct surgical peritoneal staging,” the authors concluded. “These observations confirm the possibility to identify a subset of MOGCT patients who can be spared the risk of acute and late morbidity and mortality associated with chemotherapy in long-term survivors.”