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Primary treatment and survival in malignant ovarian germ cell tumors: A nationwide population-based Swedish
Camilla Sköld1, Angelique Flöter Rådestad2, Katja Stenström Bohlin3
1Department of Immunology, Genetics and Pathology, Cancer Precision Medicine, Uppsala University, Uppsala, Sweden.
Objective:
Although rare, malignant ovarian germ cell tumors (MOGCTs) account for 70 % of ovarian malignancies in women younger than 30 years. Given the rarity of MOGCTs and the limited population-based data, this study aims to examine national treatment patterns and survival in women with MOGCTs, with a focus on fertility-sparing surgery.
Methods:
This nationwide population-based study included all women (≥18 years) diagnosed with MOGCTs 2008-2022 in the Swedish Quality Register for Gynecologic Cancer. Main outcome was 5- and 10-year survival. Cox proportional regression models were used in univariable and adjusted survival analyses.
Results:
The study population included 184 women: 43 with dysgerminomas and 141 with non-dysgerminomas (including 59 immature teratomas, 33 teratomas with malignant transformation, 27 yolk sac tumors, and 22 other subtypes). All but one of the women underwent primary surgery; 54 % had fertility-sparing surgery, and no residual disease was achieved in 89 %. Adjuvant chemotherapy was given to 53 %. During a median follow-up of 5.6 years (range 0.1-15 years), 18 women died. No deaths occurred in women with fertility-sparing surgery. Ten-year relative survival was 95 % (95 % CI 88-103) and overall survival 88 % (95 % CI 82-93). Older age at diagnosis was associated with poorer survival (per year: HR 1.09, 95 % CI 1.05-1.14, p < 0.001), as was FIGO stage IV versus stage I (HR 58, 95 % CI 13-265, p < 0.001).
Conclusions:
MOGCTs had excellent survival outcomes in this nationwide population-based study, and fertility-sparing surgery was deemed safe. Future efforts should focus on improving outcomes in older women and those with stage IV disease.
Insights
Malignant ovarian germ cell tumors (MOGCTs) show excellent survival, especially with fertility-sparing surgery. Further research should focus on improving outcomes for older patients and those with advanced stage IV disease.
Area of Science:
- Gynecologic Oncology
- Reproductive Endocrinology
- Cancer Epidemiology
Background:
- Malignant ovarian germ cell tumors (MOGCTs) are rare but constitute a significant portion of malignancies in women under 30.
- Limited population-based data exists on national treatment patterns and survival for MOGCTs.
- Fertility-sparing surgery is a key consideration for young women diagnosed with MOGCTs.
Purpose of the Study:
- To analyze national treatment strategies for MOGCTs in women aged 18 and above.
- To evaluate survival rates associated with different treatment modalities, emphasizing fertility-sparing surgery.
- To identify factors influencing survival outcomes in MOGCT patients.
Main Methods:
- A nationwide population-based study utilizing the Swedish Quality Register for Gynecologic Cancer (2008-2022).
- Inclusion of all women (≥18 years) diagnosed with MOGCTs.
- Survival analysis using Cox proportional regression models for 5- and 10-year outcomes.
Main Results:
- The study included 184 women with various MOGCT subtypes.
- 54% underwent fertility-sparing surgery, with no deaths reported in this group.
- Ten-year relative survival was 95%, and overall survival was 88%. Older age and FIGO stage IV were linked to poorer survival.
Conclusions:
- MOGCTs demonstrate excellent survival rates in a nationwide cohort.
- Fertility-sparing surgery is a safe and effective treatment option for MOGCTs.
- Improving outcomes for older women and those with stage IV disease requires further focus.
