609P Effect of lymphadenectomy on fertility and prognostic outcomes in adult patients with clinically early-stage malignant ovarian germ cell tumours during fertility-sparing surgery: A retrospective multicenter study

Abstract

Malignant ovarian germ cell tumors(MOGCT), as a rare type of the ovarian malignancies, have an excellent prognosis when treated by surgery followed by platinum-based chemotherapy. Based on the current clinical practice guidelines, systematic lymphadenectomy (LND) can be omitted for child and adolescent patients with early-stage MOGCT. However the clinical role of LND for adult patients with early-stage MOGCT remains ambiguous. The purpose of this retrospective multicenter study was to evaluate the effect of systematic LND on prognostic and fertility outcomes in adult patients with clinically stage I malignant ovarian germ cell tumors MOGCTs who received fertility-sparing surgery (FSS) treatment. This study included 168 adult MOGCTs patients who underwent FSS and were deemed to have disease clinically confined to the ovary during surgery (stage I) between 2005 to 2020 from four major university-teaching hospitals. The Propensity score matching (PSM) algorithm was adopted to reduce the bias resulting from differences of clinical characteristics. Of the 168 patients, 92 (54·8%) underwent LND and 76 (45·2%) did not. Sixty patients attempted pregnancy, with the pregnancy rate of 81·7% and live birth rate of 66·7%. In the before PSM cohort, no-LND patients showed a better pregnancy rate than LND patients (93.3% versus 70.0%, P=0.020). However, in the after PSM cohort, there were no significant differences in pregnancy rates (92.9% versus 76.9%, P=0.326). Univariate logistic regression analysis showed that age ≤25 years (OR 3.50, 95%CI 1.11-11·01, P=0.032) correlated with better live birth. Regarding the prognosis, only 3 (0.18%) patients had recurrence and no patient died after a median follow-up of 65 months. Disease-free survival (DFS) was similar between patients treated with LND and no-LND in the before and after PSM cohorts(P>0.05). LND provided no significant benefit on both prognostic and fertility outcomes for adult patients with clinically early-stage (stage I) MOGCTs who underwent FSS in our study. Meanwhile, age ≤25 years was associated with a better live birth rate.