Malignant Ovarian Germ Cell Tumors Research Articles

Premature ovarian insufficiency caused by the treatment of ovarian malignant mixed germ cell tumor: a case report

Background: Premature ovarian insufficiency (POI) will bring women early and long-term adverse consequences, including estrogen deficiency-related symptoms (hot flashes, sweating, decreased libido, insomnia, etc.) and significantly increases the risk of chronic diseases including Alzheimer's disease, cardiovascular disease and osteoporosis, along with increased risk of early death. More importantly, POI has greater harm to women’s fertility. Mostly the causes of POI are unknown. Most important are iatrogenic factors such as radiotherapy, chemotherapy and surgery, which increase the risk of POI.

Clinical Challenges in the Management of Malignant Ovarian Germ Cell Tumours.

Nonepithelial ovarian cancers (NEOC) are a group of rare malignancies, including germ cell tumours (GCT) and sex cord-stromal tumours (SCST), along with small-cell carcinomas and sarcomas. GCTs represent 2-5% of ovarian cancers, with a yearly incidence of 4:100,000, and they usually affect young women and adolescents. Precursory germ cells of the ovary form the basis of GCT. They are histologically classified into primitive GCT, teratomas, and monodermal and somatic-type tumours associated with dermoid cysts. A primitive GCT can be either a yolk sac tumour (YST), dysgerminoma, or mixed germ cell neoplasm. Teratomas are either mature (benign) or immature (malignant). Given that malignant GCTs occur rarely compared to epithelial ovarian tumours (EOC), greater focus is required in their diagnosis and treatment. In this article, we review the epidemiology, clinical manifestations, diagnosis, and molecular biology, along with the management and therapeutic challenges.

Expression of p16 Tumor Suppressor Protein in Malignant Ovarian Germ Cell Tumors; Immunohistochemical Study.

Malignant ovarian germ cell tumors represent small percentage of malignant ovarian neoplasms but they affect significantly young age group. To investigate the immunohistochemical expression of p16 tumor suppressor protein in malignant ovarian germ cell tumors. Twenty-two malignant ovarian germ cell tumors (five dysgerminoma, eight immature teratoma, and nine yolk sac tumors), twenty mature cystic teratoma tumors and twenty normal ovarian tissue were immunohistochemically stained with p16 monoclonal antibody. Ki67 immunohistochemical staining was done for malignant ovarian germ cell tumors to assess proliferation. We found that p16 tumor suppressor protein is overexpressed in all malignant ovarian germ cell tumors in both nuclear and cytoplasmic locations compared to control and to mature cystic teratoma (p-value <0.001). Cytoplasmic p16 expression was significantly correlated to Ki67 proliferation index in malignant ovarian germ cell tumors (p-value = 0.033, r = 0.445). Overexpression of p16 in malignant ovarian germ cell tumors denotes that dysfunction of the cyclin dependent kinase pathway is involved in tumorigenesis of malignant ovarian germ cell tumors.

Cancer Stem Cell Markers Are Differentially Expressed in Malignant Ovarian Germ Cell Tumors.

The objective of this study was to analyze the expression and potential clinical role of cancer stem cell (CSC) markers in malignant ovarian germ cell tumors (MOGCT). CD34, CD44, and SOX2 protein expression by immunohistochemistry was analyzed in 49 MOGCT from patients treated in Norway during the period 1980-2011. Expression was analyzed for association with tumor type and clinicopathologic parameters. Tumors were diagnosed as dysgerminoma (DG; n=15), immature teratoma (IT; n=15), yolk sac tumor (YST; n=12), embryonal carcinoma (n=2), and mixed MOGCT (n=5). Tumor cell CD34 expression was significantly more common in YST, whereas stromal expression was only seen in IT (both P <0.001). CD44 was infrequently expressed, most often focally, in tumor cells, particularly in YST ( P =0.026). CD44 was widely expressed in leukocytes, most prominently in DG. SOX2 was most frequently expressed in IT, with predominantly focal expression in some YST and uniform absence in DG ( P <0.001). Stromal CD34 ( P =0.012) and tumor cell SOX2 expression ( P =0.004) were negatively associated with the involvement of the ovarian surface, presumably due to the low incidence of this event in IT. No significant association was found between CSC marker expression and other clinicopathologic parameters, including age, laterality, tumor diameter, and FIGO stage. In conclusion, CSC markers are differentially expressed in various MOGCT types, suggesting differences in the regulation of cancer-related processes. Expression of CD34, CD44, and SOX2 does not appear to be associated with clinical parameters in this patient group.

Prognosis of lymphadenectomy in malignant ovarian germ cell tumor.

The routine application of lymphadenectomy remains a controversial part of surgical staging in malignant ovarian germ-cell tumor (MOGCT). Thus, studies are needed to explore the prognostic significance of lymphadenectomy in MOGCT. The goal of this retrospective study was to report the clinical outcomes of lymph node dissection (LND) and non-LND in MOGCT surgeries. A total of 340 cases of MOGCTs were included: 143 patients (42.1%) had LND and 197 (57.9%) had no LND. The OS rates at 5 years in the LND and non-LND group were 99.3% vs. 100%, respectively. The DFS rates at 5 years in the LND and non-LND group were 88.8% vs. 88.3%. Forty-three patients (12.6%) were successfully pregnant during the postoperative follow-up. There were 44 recurrences (12.9%) and six deaths (1.8%). Stage was an independent prognostic factor for DFS in the multivariate analysis. Pathology was reported as an independent prognostic factor associated with OS in the multivariate analysis. Lymphadenectomy had no significant influence on the OS (P=0.621) or disease-free survival rate (P=0.332) of patients with MOGCT.

METASTATIC YOLK SAC TUMOUR: A DIAGNOSTIC DILEMMA CASE REPORT AND LITERATURE REVIEW

Ovarian germ cell tumors (OGCTs) account for about 15~20% 1 of all ovarian neoplasms . Malignant ovarian germ cell tumors (MOGCTs) are rare, accounting for 3–5% of all 2 malignant ovarian neoplasms . Yolk sac tumor (YST) also referred to as endodermal primitive tumor is the second most 3 common tumor in MOGCTs. YST accounts for 20% of MOGCTs and commonly affects young women and adolescent girls between 18-30 years of age. Around one third 1 of YSTs affect premenarchal girls. When compared with epithelial ovarian tumors, YST is highly malignant with a propensity for rapid growth and acute development of symptoms. YSTs rapidly metastasize, intruding all intra4 abdominal structures as well as retroperitoneal lymph nodes. Before the advent of combination chemotherapy, YSTs were associated with poor prognosis. The introduction of novel chemotherapeutic regimens has been associated with signicantly improved 5-year survival rates of YST from 14% 5 to nearly 90%. The prognosis even for the advanced stages has remarkably improved with the addition of cisplatin to the 6 chemotherapy regimens.

Malign over germ hücreli tümörlerde klinikopatolojik özelliklerin prognoza etkisi

Purpose: Malignant ovarian germ cell tumors cause 5% of ovarian cancers. Studies examining prognosis and survival rates are significant due to malignant ovarian germ cell tumors' rarity. We aimed to investigate outcome and prognostic factors in these patients.&#x0D; Materials and Methods: The study includes clinicopathological records of malignant ovarian germ cell tumor patients in our clinic between April 1992 and November 2017. Demographic and clinical characteristics, pathological observations, adjuvant treatment modalities, and follow-up details were analyzed, and their survival effects were investigated.&#x0D; Results: One hundred fifteen patients with malignant ovarian germ cell tumors were analyzed. Most patients were reproductive-age nulliparous. The patients' mean age was 27.5+14.3, and the mean follow-up was 71.04 months. The research includes 42 dysgerminomas, 37 immature teratomas, 17 mixed germ-cell tumors, 16 endodermal sinus tumors, and three embryonic carcinomas. The disease stage was 1, 2, 3, and 4 in 53%, 16.5%, 25.2%, and 5.2% of patients, respectively.&#x0D; Fertility-sparing surgery was conducted in 55 of 79 patients, and 34.5% received pregnancy. Five-year overall survival was 74%. Localization of tumors, non-optimal cytoreduction, advanced-stage disease, poor differentiation, metastasis, and mixed cell histology were determined as poor prognostic factors. In multivariate analyzes, factors affecting disease-free survival are the FIGO stage, mixed germ cell histology, and suboptimal cytoreduction.&#x0D; Conclusion: The prognosis of malignant ovarian germ cell tumors is excellent, especially in young, early-stage, and adequately operated patients. FIGO Stage, mixed germ cell histopathology and complete cytoreduction affect the prognosis of MOGCT. Treatment at reproductive age does not significantly affect pregnancy outcomes. Therefore, the fertility sparring approach should be considered a good option, especially in young patients.

Assessment of proliferative activity of immature ovarian teratomas using AgNOR technology

Germ cell tumors arise from the covering stem cells on the surface of the embryonic ovary. They make up 20-30% of all types of ovarian tumors. About 95% are benign and present as mature cystic teratoma, and only 5% are malignant. Malignant germ cell tumors of the ovary represent 2.6% of all malignant tumors of the ovary, in contrast to epithelial tumors of the ovary (95%). A high incidence of ovarian malignant germ cell tumors is observed in the first two decades of life. Determining the prognosis of germ cell tumors of the ovary is a complex and problematic issue, and according to the existing literature, various methods are used to determine a more accurate classification of cases. One of them can be used AgNOR staining, which is called one of the means of proliferation assessment in the case of different tumors, as well as in the differentiation of dysplasias and benign and malignant processes. According to our research, it is used to evaluate proliferative activity during different histological differentiation of immature teratomas.

Psychological distress and its influencing factors in survivors of malignant ovarian germ cell and sex-cord stromal tumors—an analysis of the AGO-CORSETT database

Zusammenfassung Hintergrund Keimstrangstroma(SCST)- und Keimzelltumoren (MOGCT) sind seltene ovarielle Neoplasien, die häufig bei Jugendlichen oder prämenopausalen Patientinnen auftreten. Die Prognose ist in allen Stadien gut, weshalb psychisches Wohlbefinden, Lebensqualität, Fertilitätserhalt und Kinderwunsch zu relevanten Themen der Langzeitüberlebenden werden. Ziel der Arbeit Untersuchung der Prävalenz der fertilitätserhaltenden Therapie bei Patientinnen mit ovariellen Keimstrangstromatumoren und Keimzelltumoren und die Erfassung von Zusammenhängen mit Angst, Depression, Lebensqualität und Sexualität nach Therapie. Material und Methoden Die Current-Ovarian-geRM-cell-and-Sex-Cord-stromal-Tumour-Treatment-strategies(CORSETT)-Studie ist eine multizentrische, retro- und prospektiv beobachtende Kohortenstudie der Arbeitsgemeinschaft für Gynäkologische Onkologie (AGO) der Deutschen Krebsgesellschaft. Patientinnen nach Keimstrangstroma- oder Keimzelltumorbehandlung wurden gebeten, Fragebögen zu beantworten (Hospital Anxiety and Depression Scale [HADS], Sexual Activity Questionnaire [SAQ], European Organisation for Research and Treatment of Cancer Core Quality of Life Questionnaire [EORTC QLQ-C30]). Im Fokus dieser Analyse standen der Stellenwert der fertilitätserhaltenden Operation sowie die Ausprägung und potenziellen Zusammenhänge mit Sexualität, Lebensqualität, Schmerz, Angst und Depressivität. Ergebnisse Von 355 eingeschlossenen Patientinnen hatten 152 Patientinnen die Fragebögen ausgefüllt und wurden in die Analysen eingeschlossen. 85 Patientinnen hiervon (56 %) wurden fertilitätserhaltend operiert. 34 % der Patientinnen hatten klinisch relevante Angst und Depressivität. Patientinnen nach fertilitätserhaltender Operation waren signifikant häufiger sexuell aktiv, hatten mehr sexuelles Verlangen und litten seltener unter Angst und Depressivität als Patientinnen ohne fertilitätserhaltende operative Therapie. Das Ausmaß von Angst und Depressivität korrelierte mit dem Schmerzniveau, unabhängig vom zeitlichen Abstand zur Krebsdiagnose. Diskussion Die fertilitätserhaltende operative Therapie sollte, wann immer onkologisch vertretbar, den Patientinnen mit SCST und MOGCT angeboten werden, um den Krebsüberlebenden bestmögliche Lebensqualität zu ermöglichen. Ein wiederholtes Screening auf Angst, Depressivität, Schmerzen und Probleme in der Sexualität sollte anhand von standardisierten Fragebögen bei allen Patientinnen durchgeführt werden.

A Rare Case of Malignant Ovarian Germ Cell Tumor: Dysgerminoma and Seminoma in the Same Patient

Ovarian malignant germ cell tumors (OMGCTs) represent a rare type of malignant tumors composed of primitive germ cells that often originate from dysgenetic gonads and are frequently associated with hermaphroditism. Such tumors occur more frequently in adolescents or young adults, and their etiopathogenic mechanism is not well established. We report the case of a 20-year-old female with ovarian dysgenesis and female phenotype. A laparoscopic surgery was performed, and ovotestis was discovered. To achieve a histopathological examination, right oophorectomy was performed, which confirmed the diagnosis of dysgerminoma. In the case of hermaphroditism, mixed germ cell tumors can develop, leading to a more aggressive evolution with bilateral malignancy of the gonads, which requires the removal of both ovotestis. The patient was recalled. A histopathological examination revealed a seminoma, so laparoscopic left oophorectomy was performed. The management of this type of diagnosis primarily involves surgery, minimally invasive interventions being preferred. Not all pathologic conditions are readily identifiable by means of exploratory laparoscopy, as in our patient’s case. We consider that the optimal solution for these patients would be the preservation of fertility via egg donation and embryo transfer; the survival rate of such patients being 97–100%, if the tumor is diagnosed at an early age.

20P A single-center retrospective analysis of clinical patterns, management and survival outcomes of malignant ovarian germ cell tumors

20P A single-center retrospective analysis of clinical patterns, management and survival outcomes of malignant ovarian germ cell tumors

71P Survival outcomes of patients with recurrent malignant ovarian germ cell tumors: A retrospective analysis from a tertiary cancer center

Treatment of recurrent malignant ovarian germ cell tumors (MOGCT) are complex and challenging. There is limited data on outomes of these patientsafter salvage therapy in real world setting. This is a retrospective study of all patients diagnosed with recurrent MOGCT at our center between 2013-2017. Out of 43 patients 12 patients were excluded as they have not followed up after first visit. Clinico-pathological and treatment details of 31 patients were extracted from electronic medical records and were included in the analysis. Table: 71PVARIABLEPATIENTS (%)STAGE AT BASELINEIAICIII/IVUnknown11 (35%)5 (16%)5/3 (16%/9%)7 (22%)HISTOLOGYDysgerminomaYolk sacTeratomaMixed GCT8 (26%)6 (19%)10 (32%)7 (22%)ADEQUACY OF TREATMENT AT BASELINEAdequateInadequateMissing22 (71%)8 (26%)1 (3%)SITES OF RECURRENCEPeritoneum+ pelvis-20 (65%)Lymph node- 8 (25%)Liver+ lung- 3 (9%) Open table in a new tab Baseline characteristics initial stage, adequacy of treatment, sites of recurrence and treatment were in tabular form. Salvage chemotherapy was given in all patients. Ten (33%) patients who were inadequately treated upfront at outside recieved BEP/ EP as salvage regimen in our centre. Other regimens used were VeIP 8 (25%), TIP 6 (19%) and VIP 4 (13%) Others 3 (10%). After salvage chemotherapy 19 (61%) patients underwent second surgery, R0 resection was achieved in 13 (42%) patients. After median follow up of 66 months, 21 patients were alive (18-with no disease, and 3 were alive with stable teratoma component) after salvage therapy, and 10 patients were dead. Out of 13 patients with yolk sac histology (Pure yolk sac -6; Mixed GCT-7) only 6 could be salvaged. Those who could not be salvaged had effusions or extensive liver disease. Two patients out of 8 reccurent dysgerminoma had bulky multi station lymph nodal relapse could not be salvaged. The median PFS was after relapse was 26 months and median OS was 33 months post relapse. Adequate treatment at initial diagnosis is of paramount importance along with active surveillance to minimize default rates especially in low middle-Income countries. 67% of our recurrent cases were effectively salvaged. If managed at experienced centres with multidisciplinary approach using salvage chemotherapy and surgery, majority of recurrences can result in long term cure.

67P Survival and reproductive outcomes of patients with malignant ovarian germ cell tumors, a retrospective analysis from a tertiary care center in India

67P Survival and reproductive outcomes of patients with malignant ovarian germ cell tumors, a retrospective analysis from a tertiary care center in India

Study of neoadjuvant chemotherapy in advanced malignant ovarian germ cell tumors at a tertiary center in western India.

To study clinical characters and outcomes in patients of malignant ovarian germ cell tumor (MOGCT) undergoing surgery following neoadjuvant chemotherapy (NACT). Retrospective study of patients undergoing surgery following NACT for MOGCT at our institute. Platinum based chemotherapy was given in all patients in NACT. Between March 2013 and February 2023, 30 patients had surgery after NACT. Patient's median age was 22 years (range, 12 to 35 years) and median follow up 42months (range, 6 to 132 months). Majority had endodermal sinus tumor (n=12), dysgerminoma (n=9) and mixed GCT (n=7). All had either International Federation of Gynecology and Obstetrics (FIGO) stage 3 (n=19) or FIGO stage 4 disease (n=11). Complete response to NACT seen in 5 patients and 23 patients had partial response. Fertility sparing surgery in 18 patients and complete surgery in 12 patients. Suboptimal surgery was seen in 4 patients. Currently, 20 of 30 patients are alive and disease free, 3 lost for follow up and 7 patients had progression after adjuvant therapy. Five patients had mortality-4 with progression and 1 with bleomycin toxicity. Fifteen of 17 eligible patients have resumed menstruation and one had successful pregnancy. Prognostic factors noted in study are stage, optimal surgery and viable tumor in histopathology. Dysgerminoma had better outcome than other histology. NACT may be a reasonable option in patients with extensive unresectable disease or in whom fertility sparing is not possible or in the poor general condition. Fertility sparing surgery can be attempted post neoadjuvant chemotherapy without adversely affecting prognosis.

Different Clinical Presentations of Malignant Ovarian Germ Cell Tumors based on Age, Parity and Histology

Background: Ovarian tumors are mostly detected in advanced stages. Early diagnosis of malignant ovarian germ cell tumors is so vital to keep life and fertility of the patients. We aimed to find out different presentations of malignant ovarian germ cell tumors based on age, parity and histology to help early diagnosis of the tumors.&#x0D; Methods: In this study, malignant ovarian germ cell tumors admitted in a referral center of gynecology oncology were studied 2001-2018. The symptoms and signs of the patients were collected and analyzed according to age, parity and specific histology.&#x0D; Results: 128 cases of malignant germ cell tumors were detected. The primary symptoms included abdominal distension (45%), acute pain (40.95%), chronic pain (23.95%), menstrual irregularity (14.7%), sense of abdominal firmness and mass (7.72%), nausea (5.4%), fever (5.4%), lack of appetite (4.63%), virilization (3.1%), depletion of weight (3.1%), and 9.27% detected incidentally. Abdominal distension, and acute pain decreased after 24. Menstrual disorders and incidental detection in multiparas were significantly more than nulliparous (p&lt;0.05). Abdominal distension was the prominent sign in dysgerminomas (50%). Almost 45% of immature, yolk sac, and mixed tumors referred with acute abdominal pain. The data showed that 85% of the patients had been suffering from some discomforts for days to months prior to the diagnosis.&#x0D; Conclusion: The majority of cases are symptomatic for a long time before the first visit although aging and parity can lessen their severity. Late diagnosis can lead to acute abdomen in some histology types. Young women and health providers should be warned about concerned presentations of ovarian tumors.

Diagnosis and Management of Dysgerminomas with a Brief Summary of Primitive Germ Cell Tumors.

Dysgerminoma represents a rare malignant tumor composed of germ cells, originally from the embryonic gonads. Regarding its incidence, we do not have precise data due to its rarity. Dysgerminoma occurs at a fertile age. The preferred treatment is the surgical removal of the tumor succeeded by the preservation of fertility. Even if a multidisciplinary team, founded in 2009 by a gynecologist, an oncologist, a pediatric oncologist and a pediatric surgeon, under the guidance of the Malignant Germ Cell International Consortium (MaGIC), studies this type of tumor, issues still remain related to the lack of a randomized study and to both the management and understanding of the concept of OMGCTs (ovarian malignant germ cell tumors). The aim of this review is to present from the literature the various approaches for this type of tumor, and, regarding innovative therapies or possible prevention, which can be applied in clinical practice. Multidisciplinarity and treatment in reference centers have proven their usefulness as well.

Assessment of prognostic and reproductive outcomes of omentectomy for patients with clinically apparent early-stage (I, II) malignant ovarian germ cell tumours: A multicentre retrospectivestudy.

This study assessed the effect of omentectomy on the prognosis and fertility in patients with clinically early-stage (I, II) malignant ovarian germ cell tumours (MOGCT). A retrospective multicentre study. Four university teaching hospitals in China. A total of 268 patients with clinically apparent early-stage (I, II) MOGCT. Data were obtained from the medical records. Additionally, the propensity score matching (PSM) algorithm was adopted. Prognostic outcomes were disease-free survival (DFS) and overall survival (OS). Fertility outcomes were pregnancy and live birth rates. A total of 187 (69.8%) patients underwent omentectomy. Kaplan-Meier analysis showed no significant differences in DFS and OS between the omentectomy and non-omentectomy groups before and after PSM (p > 0.05). Additionally, subgroup analysis stratified by age (<18 and ≥18 years) showed similar results. International Federation of Gynecology and Obstetrics (FIGO) stage was the only risk factor associated with DFS (hazard ratio [HR] 14.71, 95% confidence interval [CI] 4.47-48.38, p < 0.001) and OS (HR 37.36, 95% CI 3.87-361.16, p=0.002). Pregnancy and live birth rates in the total population were 80.3% and 66.7%, respectively. There were no significant differences between the two groups before and after PSM. Omentectomy did not improve survival or affect fertility in patients with clinically apparent early-stage (I, II) MOGCT, regardless of the age. The clinical FIGO stage was an independent risk factor for recurrence and death.

Editorial: Towards better and personalized management of ovarian cancer in China

Ovarian cancer remains the most lethal gynaecological malignancy worldwide, with 313 959 newly diagnosed cases and 207 252 deaths annually; approximately one-sixth of which occur in China.1 Despite the advances in the treatment of ovarian cancer, its 5-year survival rate has not surpassed 45%.2 In this supplement to the British Journal of Obstetrics and Gynaecology, eight manuscripts that focus on ovarian cancer therapy efficacy and consequences, therapeutic and prognostic biomarkers, shifts in treatment patterns, and establishment of big data gynaecological oncology platforms are included to outline the recent advances in our understanding of ovarian cancer management in China. Primary debulking surgery (PDS) followed by chemotherapy or neoadjuvant chemotherapy (NACT) and then interval debulking surgery (IDS) has been the standard of care for advanced epithelial ovarian cancer (EOC), and the absence of residual tumour after surgery is an important determinant of survival. Sun et al. summarised EOC-targeted fluorescent probes and open-field fluorescence imaging strategies to eradicate submillimetre and intraperitoneally scattered tumour masses to achieve complete resection. However, complete resection does not benefit all ovarian cancer subtypes. Liu et al. conducted a multicentre retrospective study and revealed that omentectomy did not improve survival and had no impact on pregnancy or live birth rates in apparently early malignant ovarian germ cell tumours. Therefore, prospective clinical trials are required to validate our conclusions. Intraperitoneally scattered tumour masses of ovarian cancer provide a rationale for the utilisation of intraperitoneal chemotherapy (IP). However, current randomised clinical trials failed to demonstrate the survival benefits of IP.3 Xiang et al. took advantage of the follow-up population of the AICE trial4 to conduct a treatment-free survival (TFS) analysis and demonstrated that patients with high tumour burden achieved significantly longer TFS and quality-adjusted overall survival (OS) compared with their counterparts with low tumour load when treated with IP followed by intravenous chemotherapy. Hyperthermic IP (HIPEC) after PDS improved the survival of EOC,5 but HIPEC in the neoadjuvant setting (NHIPEC) has not been sufficiently studied. Wu et al. demonstrated that NHIPEC plus NACT resulted in significantly prolonged progression-free survival (PFS) compared with NACT alone in patients with advanced high-grade serous ovarian cancer (HGSOC) in a retrospective study. Approximately 50% of HGSOC cases suffer from homologous recombination deficiency (HRD), which enables synthetic lethality with poly (ADP-ribose) polymerase (PARP) inhibition. Yuan et al. constructed a genomic scar model to predict HRD using machine learning algorithms, which demonstrated a sensitivity over 97% in detecting BRCA-deficient events and exhibited robustness in identifying responders to PARP inhibitors (PARPi). Treatment-naïve ovarian cancer often has a high response rate to platinum-based chemotherapy; however, platinum resistance inevitably emerges. Wu et al. revealed that co-expression of SLC7A11 and GPX4, two pivotal ferroptosis-related proteins, is significantly associated with platinum resistance and predicts worse PFS and OS. Liu et al. investigated the association among the primary treatment sequence (PDS versus NACT-IDS), recurrence characteristics, and post-relapse survival (PRS) based on real-world evidence. NACT-IDS was revealed as an independent risk factor for decreased PRS and was significantly associated with a shortened progression-free interval and a diffuse pattern of recurrence. China has the largest gynaecological oncology population worldwide and produces tremendous quantities of real-world disease- and treatment-related data. Zeng et al. established the National Union of Real-world Gynecological Oncology Research and Patient Management Platform (NUWA platform), the first large, scalable longitudinal clinico-genomic database in China that integrates multidimensional data on gynaecological oncology. They presented the implementation status and quality control methodology of the platform and leveraged the currently available data derived from 11 456 patients with ovarian cancer to display treatment pattern shifts in recent years. We are grateful to all the authors for their contributions and to British Journal of Obstetrics and Gynaecology for publishing this special issue. We believe that the contents of this issue will help readers understand the efforts of Chinese clinicians and researchers to facilitate better and personalised management of ovarian cancer in China.

Oncology and reproductive outcomes over 16 years of malignant ovarian germ cell tumors treated by fertility sparing surgery.

Malignant ovarian germ cell tumors (MOGCT) are rare and frequently occur in women of young and reproductive age and the oncologic and reproductive outcomes after fertility-sparing surgery (FSS) for this disease are still limited. To evaluate the oncology and reproductive outcomes of MOGCT patients who underwent FSS. All MOGCT patients who underwent FSS defined as the operation with a preserved uterus and at least one side of the ovary at our institute between January 2005 and December 2020 were retrospectively reviewed. Sixty-two patients were recruited for this study. The median age was 22 years old and over 77% were nulliparous. The three most common histology findings were immature teratoma (32.2%), dysgerminoma (24.2%), and yolk sac tumor (24.2%). The distribution of stage was as follows; Stage I, 74.8%; stage II, 9.7%; stage III, 11.3%; and stage IV, 4.8%. Forty-three (67.7%) patients received adjuvant chemotherapy. With a median follow-up time of 96.3 mo, the 10-year progression-free survival and overall survival were 82.4% and 91%, respectively. For reproductive outcomes, of 43 patients who received adjuvant chemotherapy, 18 (41.9%) had normal menstruation, and 17 (39.5%) resumed menstruation with a median time of 4 mo. Of about 14 patients who desired to conceive, four were pregnant and delivered good outcomes. Only one case was aborted. Therefore, the successful pregnancy rate was 28.6. The oncology and reproductive outcomes of MOGCT treated by FSS are excellent. Many patients show a long survival time with normal menstruation. However, the obstetric outcome is not quite satisfactory.

Depression and anxiety in women with malignant ovarian germ cell (MOGCT) and sex cord stromal tumors (SCST): an analysis of the AGO-CORSETT database

IntroductionThe intention of this study was to evaluate the level of anxiety and depression of malignant ovarian germ cell (MOGCT) and sex cord stromal tumors (SCST) survivors and to identify possible alterable cofactors.MethodsCORSETT was an observational, multicenter, mixed retrospective/prospective cohort study of the AGO Studygroup. Women who had been diagnosed with MOGCTs and SCSTs between 2001 and 2011 were asked to complete the Hospital Anxiety and Depression Scale (HADS) to evaluate distress. Predictors of distress (type of surgery, chemotherapy, time since diagnosis, recurrence, second tumor, pain) were investigated using multivariate linear regression analysis.Results150 MOGCT and SCST patients with confirmed histological diagnosis completed the questionnaire median seven years after diagnosis. They had a HADS total score ≥ 13 indicating severe mental distress in 34% of cases. Patients after fertility-conserving surgery had lower probability of severe mental distress than those without fertility-conserving treatment (β = − 3.1, p = 0.04). Pain was associated with the level of distress in uni- and multivariate analysis (coef 0.1, p < 0.01, coef. Beta 0.5).DiscussionSevere mental distress was frequent in patients with MOGCT and SCST and the level of pain was associated with the level of distress. Fertility conserving therapy, however, was associated with less mental distress. Screening and treatment of pain and depression is required to improve mental well-being in survivors of MOGCT and SCST.