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South Asian J Cancer. 2019 Jan-Mar;8(1):35-40. doi: 10.4103/sajc.sajc_6_18.

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

Author information

1
Department of Gynecologic Oncology, Amrita Institute of Medical Sciences, Amrita University, Kochi, Kerala, India.
2
Department of Medical Oncology, Amrita Institute of Medical Sciences, Amrita University, Kochi, Kerala, India.
3
Department of Pathology, Amrita Institute of Medical Sciences, Amrita University, Kochi, Kerala, India.
4
Department of Surgical Oncology, Amrita Institute of Medical Sciences, Amrita University, Kochi, Kerala, India.
5
Department of Biostatistics, Amrita Institute of Medical Sciences, Amrita University, Kochi, Kerala, India.

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.

KEYWORDS:

Active surveillance; comprehensive surgical staging; incomplete surgery; malignant ovarian germ cell tumor; neoadjuvant chemotherapy; pediatric surgical staging

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