Early adjuvant chemotherapy administration for patients with advanced stage (III-IV) malignant ovarian germ cell tumors is associated with a survival benefit (153)

Abstract

Objectives: Malignant ovarian germ cell tumors (MOGCTs) are usually chemo-sensitive but characterized by rapid tumor growth. While for patients with epithelial ovarian carcinoma, delay in adjuvant chemotherapy administration is associated with worse oncologic outcomes, data for patients with MOGCT are scarce. The present study aimed to evaluate the impact of adjuvant chemotherapy administration timing on the survival of patients with advanced-stage MOGCTs who underwent surgical resection. Methods: The National Cancer Database (NCDB) was accessed. Patients with no history of another tumor diagnosed between 2004 and 2015 with stage III-IV MOGCT, who underwent surgical resection and received multi-agent chemotherapy, had known surgery-chemotherapy intervals, and at least one month of follow-up were identified. Overall survival (OS) was compared between patients who received chemotherapy 1-4 weeks (early administration group) and 4-12 weeks (late administration group) from surgery with the log-rank test following generation of Kaplan-Meier curves. A Cox model was constructed to control for a priori selected confounders. Results: A total of 622 patients with advanced-stage MOGCT who met the inclusion criteria were identified. The median surgery-chemotherapy interval was 25 days (IQR: 18). The early and late chemotherapy administration groups included 393 (63.2%) and 229 (36.8%) patients, respectively. Patients in the early administration group were younger (median age: 22 vs 24 years, p<0.001) compared to those in the late administration group. However, the two groups were comparable in terms of patient race, insurance status, presence of medical comorbid conditions, tumor histology, and disease stage (p>0.05). By univariate analysis, patients in the early administration group had better OS than those in the late administration group (p=0.004); 5-year OS rates were 87.5% and 77.6%, respectively. After controlling for patient age, race, presence of medical comorbid conditions, tumor histology, and disease stage, late chemotherapy administration was associated with worse survival (HR: 1.99, 95% CI: 1.34, 3.01). Conclusions: For patients with advanced-stage MOGTCs, administration of chemotherapy within four weeks from surgery should be strongly considered since delay may be associated with worse overall survival. Objectives: Malignant ovarian germ cell tumors (MOGCTs) are usually chemo-sensitive but characterized by rapid tumor growth. While for patients with epithelial ovarian carcinoma, delay in adjuvant chemotherapy administration is associated with worse oncologic outcomes, data for patients with MOGCT are scarce. The present study aimed to evaluate the impact of adjuvant chemotherapy administration timing on the survival of patients with advanced-stage MOGCTs who underwent surgical resection. Methods: The National Cancer Database (NCDB) was accessed. Patients with no history of another tumor diagnosed between 2004 and 2015 with stage III-IV MOGCT, who underwent surgical resection and received multi-agent chemotherapy, had known surgery-chemotherapy intervals, and at least one month of follow-up were identified. Overall survival (OS) was compared between patients who received chemotherapy 1-4 weeks (early administration group) and 4-12 weeks (late administration group) from surgery with the log-rank test following generation of Kaplan-Meier curves. A Cox model was constructed to control for a priori selected confounders. Results: A total of 622 patients with advanced-stage MOGCT who met the inclusion criteria were identified. The median surgery-chemotherapy interval was 25 days (IQR: 18). The early and late chemotherapy administration groups included 393 (63.2%) and 229 (36.8%) patients, respectively. Patients in the early administration group were younger (median age: 22 vs 24 years, p<0.001) compared to those in the late administration group. However, the two groups were comparable in terms of patient race, insurance status, presence of medical comorbid conditions, tumor histology, and disease stage (p>0.05). By univariate analysis, patients in the early administration group had better OS than those in the late administration group (p=0.004); 5-year OS rates were 87.5% and 77.6%, respectively. After controlling for patient age, race, presence of medical comorbid conditions, tumor histology, and disease stage, late chemotherapy administration was associated with worse survival (HR: 1.99, 95% CI: 1.34, 3.01). Conclusions: For patients with advanced-stage MOGTCs, administration of chemotherapy within four weeks from surgery should be strongly considered since delay may be associated with worse overall survival.