Early-stage ovarian immature teratoma, surveillance, or chemotherapy after surgery? A propensity score matched analysis (486)

Abstract

Objectives: To compare the survival outcomes between surveillance and adjuvant chemotherapy in patients with stage I ovarian immature teratomas (ITs) who underwent fertility-sparing surgery. Methods: In this retrospective cohort analysis, patients with stage IA grade 2-3, stage IB and stage IC ovarian ITs who underwent surveillance after surgery between 2016 to 2021 from Peking Union Medical College Hospital were identified. A 1:1 propensity score matching was performed in patients who had adjuvant chemotherapy by age, stage, and grade. Results: A total of 16 patients without adjuvant chemotherapy were identified: three stage IA (18.75%), 13 stage IC (81.25%). The median age at diagnosis was 14.5 years (range: 3-30). There were six patients who had grade 1 tumor (37.50%), five grade 2 (31.25%), five grade 3 (31.25%). After a mean follow-up period of 24.4 months (median time: 21 months), a patient with stage IA grade 2 IT who underwent ovarian cystectomy had recurrence in the same ovary. The menstruation was not affected after treatment in all the eight patients of reproductive age. Successful pregnancy and delivery were achieved in three patients without adverse events. After propensity score matching, 16 patients who received chemotherapy were included with one recurrence. Both of the patients received second surgery and adjuvant chemotherapy after recurrence. By the time of last follow-up, all patients had no evidence of disease (NED). There was no statistical difference in 3-year disease-free survival (DFS) between the surveillance and chemotherapy groups (Log-rank p=0.808). Conclusions: We did not observe survival differences in recurrence between patients who underwent adjuvant chemotherapy or not among patients with stage I ovarian ITs. Surveillance may be safe and preferable in early-stage IT patients who underwent complete resection of the tumor. Objectives: To compare the survival outcomes between surveillance and adjuvant chemotherapy in patients with stage I ovarian immature teratomas (ITs) who underwent fertility-sparing surgery. Methods: In this retrospective cohort analysis, patients with stage IA grade 2-3, stage IB and stage IC ovarian ITs who underwent surveillance after surgery between 2016 to 2021 from Peking Union Medical College Hospital were identified. A 1:1 propensity score matching was performed in patients who had adjuvant chemotherapy by age, stage, and grade. Results: A total of 16 patients without adjuvant chemotherapy were identified: three stage IA (18.75%), 13 stage IC (81.25%). The median age at diagnosis was 14.5 years (range: 3-30). There were six patients who had grade 1 tumor (37.50%), five grade 2 (31.25%), five grade 3 (31.25%). After a mean follow-up period of 24.4 months (median time: 21 months), a patient with stage IA grade 2 IT who underwent ovarian cystectomy had recurrence in the same ovary. The menstruation was not affected after treatment in all the eight patients of reproductive age. Successful pregnancy and delivery were achieved in three patients without adverse events. After propensity score matching, 16 patients who received chemotherapy were included with one recurrence. Both of the patients received second surgery and adjuvant chemotherapy after recurrence. By the time of last follow-up, all patients had no evidence of disease (NED). There was no statistical difference in 3-year disease-free survival (DFS) between the surveillance and chemotherapy groups (Log-rank p=0.808). Conclusions: We did not observe survival differences in recurrence between patients who underwent adjuvant chemotherapy or not among patients with stage I ovarian ITs. Surveillance may be safe and preferable in early-stage IT patients who underwent complete resection of the tumor.