Malignant Ovarian Germ Cell Tumor—Survival and Reproductive Outcomes and Patterns of Relapse

BACKGROUND: Malignant ovarian germ cell tumors [MOGCT] are rare cancers affecting young women and often present in advanced stages. This study aimed to evaluate their survival outcomes. METHODS: This is a retrospective study of patients diagnosed with MOGCT between 2013 to 2018. Clinicopathologic data were retrieved from electronic medical records. Survival analysis was done using the Kaplan-Meier method. RESULTS: A total of 170 patients were analyzed. The median age was 25 years (range: 15-68). Histological subtypes were dysgerminoma 37% (n-63), yolk sac tumor 21% (n-36), Immature teratoma 21% (n-35), mixed germ cell tumor 17% (n-29), and mature teratoma with somatic malignancy 4% (n-7). Presentation in early stage (I and II) was 64% (n = 108), while 36% (n = 62) had advanced stage (Stage III/IV). Chemotherapy was received by 134 patients, of whom 49 received it in a neoadjuvant setting. Most patients (n = 134-79%) underwent fertility-sparing surgery, of whom 87% (117 of 134) resumed menstruation after completion of chemotherapy, with 18 successful pregnancies. Patients with relapsed yolk sac tumors (4) presented with ascites and peritoneal disease and could not be salvaged. Median follow-up was 62 months [range 58-65 months]. The 5-year progression-free survival for stage I/II was 86% (95% CI 79-93) and for stage III/IV was 70% (95% CI 58-82). The 5-year overall survival for stage I/II was 99% [95% CI 97-100] and for Stage III/IV was 88% (95% CI 79-97). CONCLUSIONS: Patients presenting with advanced MOGCT can be offered fertility-sparing surgery after neoadjuvant chemotherapy with no detriment in oncological outcome.