Prognostic significance of residual disease in advanced stage malignant ovarian germ cell tumors

Abstract

ObjectiveTo investigate the prognostic significance of complete gross resection following cytoreductive surgery for patients with advanced stage malignant ovarian germ cell tumors.MethodsThe National Cancer Data Base was accessed and patients diagnosed with an advanced stage (II-IV) malignant ovarian germ cell tumor who underwent primary cytoreductive surgery between 2011 and 2014 were selected for further analysis. For analysis purposes two groups were formed: patients with complete gross resection and those with macroscopic residual disease. Demographic and clinico-pathological characteristics were compared with the chi-square and Mann–Whitney U test. Univariate survival analysis was performed with the log-rank test after generation of Kaplan–Meier curves, while a Cox proportional hazard model was constructed to evaluate mortality after controlling for confounders.ResultsA total of 343 patients who met the inclusion criteria were identified. Residual disease status was available for 276 patients: the rate of complete gross resection was 69.2 %. By univariate analysis there was no difference in overall survival between patients in the complete gross resection and macroscopic residual disease groups, P= 0.26; 3-year overall survival rates: 86.4 % and 82.8 %, respectively. No difference in overall survival was noted following stratification by histology; P = 0.64 and P = 0.24 for dysgerminoma and non-dysgerminoma tumor groups. After controlling for stage IV disease, histology and the administration of chemotherapy, macroscopic residual disease was not associated with a worse mortality (HR: 1.22, 95% CI: 0.61 to 2.46).ConclusionsMacroscopic residual disease following primary cancer-directed surgery was not associated with a worse prognosis in a cohort of patients with advanced stage malignant ovarian germ cell tumors.

Primary ovarian choriocarcinoma occurring in a postmenopausal woman: A case report

“…Because the peak incidence of NGOC occurs among adolescents and women of reproductive age, fertility-preserving treatment should be considered in patients with early-stage cancer. Although complete cytoreduction (R0) has been reported to be an independent prognostic factor[ 13 ], it is still controversial whether patients with advanced disease can be offered fertility-preserving surgery. Inaba et al [ 14 ] have reported that patients with advanced disease, with the correct diagnosis, rational treatment, and strict surveillance of serum β-hCG, can often receive fertility-sparing treatment and achieve long-term survival.…”

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“…In our series, fertility-sparing surgery was attempted whenever possible after initial diagnosis and 83.6% of patients achieved complete surgical resection. Some studies have shown that maximal debulking surgery is significantly associated with improved overall survival [21,22], while others have not [23,24]. Considering the chemotherapy-sensitive nature of MOGCTs, fertility-sparing cytoreductive surgery seems reasonable for patients in advanced stage.…”

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