Outcome and Prognostic Factors in Ovarian Germ Cell Malignancies

Abstract

Between 1984 and 2003, 93 patients (mean age 23 years) were treated for ovarian germ cell malignancy at the Chang Gung Memorial Hospital, including 9 women who received their initial treatment at an outside hospital and were referred for further evaluation after progression or recurrence of disease. All patients were treated with unilateral, if possible, or bilateral salpingocophorectomy. Pelvic and paraaortic lymphadenectomy were also performed. After 1989, a greater effort was made to preserve fertility. In general, patients with stage IA dysgerminoma or stage IA, grade 1 immature teratoma did not receive postoperative chemotherapy. Other patients were treated with a combination regimen. Before 1989, vincristine, actinomycin D, and cyclophosphamide were used initially, and cisplatin, vinblastine, and bleomycin were used in women with more advanced disease or recurrent disease. In 1989, the protocol was changed to a cisplatin, etoposide, and bleomycin combination for first-line chemotherapies. Bleomycin was not included for patients with stage I and completely resected stage II disease. Most study patients (n = 64) were stage I, 3 were stage II, 17 were stage III, and 2 were stage IV. One patient who received initial treatment at the Chang Gung Memorial Hospital and 6 who were initially treated elsewhere could not be staged and were designated stage X for analyses. Histologic diagnoses included 32 dysgerminomas, 29 immature teratomas, 23 endodermal sinus tumors, 7 mixed germ cell tumors, and 1 each of pure or embyronal choriocarcinoma. Eleven of the 93 study patients had recurrent or persistent disease, and 6 died. The mean time to recurrence was 8 months. Patients with other than dysgerminoma or immature teratoma and patients with higher disease stages were more likely to have recurrent or persistent disease (P <.0001 and P =.001, respectively). There were no deaths among women with dysgerminoma or immature teratoma who received high-dose chemotherapy after primary treatment failure or who had residual tumor less than 1 cm after primary surgery. In comparison, patient deaths were significantly associated with nondysgerminoma or immature teratoma (n = 6; P =.0004), with no salvage high-dose chemotherapy (n = 5; P =.04) and with residual tumor of 1 cm or greater (n = 6; P =.0014).