Clinicopathological Characteristics And Survival Analysis Of Ovarian Malignant Germ Cell Tumors

Objective:To investigate the clinicopathological features of ovarian malignant germ cell tumors and the prognostic factors.Methods:Review and analyze retrospectively the clinical and pathological data of 56 ovarian malignant germ cell tumor patients with complete clinicopathological and follow-up data,who were treated in the Liaoning Provincial Tumor Hospital from January in 2003 to December in 2014.Investigate the clinicopathological featu res of ovarian malignant germ cell tumors and the prognostic factors,to provide a reference for clinical practice.Results:Fifty-six malignant germ cell tumors patients with complete clinicopathological features and follow-up data had a median onset age of 23.5 years old(range from 8 to 69 years old)and 10 cases(17.86%)were more than 35 years of age.Preoperative serum tumor markers mainly included:?-HCG,AFP,LDH etc.There were 27 cases(48.21%)of at least one elevated serum tumor markers before operation.The maximum diameter of the tumor fluctuated from 3.6 cm to 26 cm.44 cases(78.57%)were greater than or equal to 10 cm.The pathological types included 17 cases(30.36%)of dysgerminoma,19 cases of immature teratoma(33.93%),10 cases of mixed germ cell tumor(17.86%),7 cases of endodermal sinus tumor(12.5%)and 3 cases of teratoma with malignant transformation(5.36%).All 56 patients underwent surgical treatment.39(69.64%)patients underwent fertility-preserving surgery.11 patients(19.64%)underwent comprehensive staging surgery.According to 2013 FIGO staging criteria,39 patients(69.64%)were in stage ?,5 patients(8.93%)in stage ?,12 patients(21.43%)in stage? and no patients in stage ?.49 patients(87.5%)achieved no residual tumor or residual lesion diameter less than 1cm after surgery.50 cases underwent postoperative chemotherapy with BEP(Bleomycin + Etoposide + Cisplatin)or BVP regimen(Bleomycin+Vincristine + Cisplatin).3 patients were treated with TC regimen(paclitaxel/docetaxel +carboplatin).Another 3 patients were not treated with chemotherapy.Neoadjuvant chemotherapy was not performed in all the patients.The 2-year PFS was 78.57%(44/56)and the 2-year OS was 89.29%(50/56).Among the 56 cases,44 cases were followed up for 5 years,9 cases died(6 cases were mixed germ cell tumors),and the 5-year PFS and 5-year OS were 63.63%(28/44)and 79.55%(35/44),respectively.Among the 56 cases,28 cases were followed up for 10 years,10 cases died(6 cases were mixed germ cell tumors).The 10-year PFS and 10-year OS were 60.71%(17/28)and 64.29%(18/28),respectively.There was statistically significant difference in the 2-year,5-year and 10-year PFS and OS of postoperative residual tumor,pathological type,FIGO staging and the number of chemotherapy courses(P<0.05).There was no statistically significant difference in the 2-year,5-year and 10-year PFS and OS of preoperative serum tumor markers and comprehensive staging surgery(P>0.05).There was statistically significant difference in the 2-year,5-year and 10-year OS and 2-year?10-year PFS of age(P<0.05),while,there was no statistically significant difference in the 5-year PFS of age(P>0.05).There was statistically significant difference in the 5-year OS,10-year OS and 10-year PFS of fertility-preserving surgery(P<0.05),while,there was no statistically significant difference in the 2-year OS,2-year PFS and 5-year PFS of fertility-preserving surgery(P>0.05).There was statistically significant difference in the 5-year OS,10-year OS and 2-year,5-year and 10-year PFS of the maximum diameter of the tumor(P<0.05),while,there was no statistically significant difference in the 2-year OS of the maximum diameter of the tumor(P>0.05).Conclusions:Postoperative residual tumor size,histopathological type,FIGO sta ging,number of chemotherapy courses,were important prognostic factors of ovarian malignant germ cell tumors.Preoperative elevated serum tumor markers and compre hensive operation had no significant effect on prognosis.Age had significant effect on the 2-year,5-year and 10-year OS and 2-year?10-year PFS,while,age had no significant effect in the 5-year PFS.Fertility-preserving surgery had significant effe ct in the 5-year OS?10-year OS and 10-year PFS,while,fertility-preserving su rgery had no significant effect in the 2-year OS?2-year PFS and 5-year PFS.The maximum diameter had significant effect in the 5-year OS,10-year OS and 2-year,5-year and 10-year PFS,while,the maximum diameter had no significant effect i n the 2-year OS.