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Outcome and Risk Factors for Recurrence in Malignant Ovarian Germ Cell Tumors: A MITO-9 Retrospective Study

Mangili, Giorgia MD*; Sigismondi, Cristina MD*; Gadducci, Angiolo MD; Cormio, Gennaro MD; Scollo, Paolo MD§; Tateo, Saverio MD; Ferrandina, Gabriella MD; Greggi, Stefano MD#; Candiani, Massimo MD*; Lorusso, Domenica MD**

International Journal of Gynecological Cancer: November 2011 - Volume 21 - Issue 8 - p 1414-1421
doi: 10.1097/IGC.0b013e3182236582
Ovarian Cancer

Aims: This study aimed to investigate the outcome of patients with malignant ovarian germ cell tumors (MOGCTs) and to define the risk factors for recurrence.

Methods: A total of 123 patients with MOGCTs were retrospectively reviewed among MITO centers. Eighty-one patients had primary treatment in a MITO center, whereas the other 42 were referred for adjuvant chemotherapy or recurrence. The clinicopathologic characteristics were evaluated for association with relapse or death.

Results: Median age was 24 years (range, 11-76 years). Forty-nine (39.8%) had dysgerminomas, 35 (28.5%) had immature teratomas, 12 (9.8%) had mixed germ cell tumors, 26 (21.1%) had yolk sac tumors, and 1 (0.8%) had embryonal carcinoma. International Federation of Gynecology and Obstetrics stage distribution was as follows: stage I, 87 (70.7%); stage II, 3 (2.4%); stage III, 29 (23.6%); and stage IV, 4 (3.3%). Fertility-sparing surgery was performed in 92 patients, whereas the remaining 31 received radical surgery; 65.8% of patients received adjuvant chemotherapy. Recurrence rate was 17.8% and the median time to recurrence was 9 months. Univariate and multivariate analyses showed that patient age (>45 years) and treatment outside a referral (MITO) center were the most important predictors of recurrence. The 5-year overall survival rate was 88.8%, with a median follow-up of 61 months. Univariate and multivariate analyses demonstrated that stage greater than I and yolk sac tumors were independent poor prognostic indicators.

Conclusions: This study confirms that MOGCTs have excellent prognosis, with 5-year overall survival rates of 95.6% and 73.2% in stage I and advanced stages, respectively. Age older than 45 years and treatment not in a referral center are independent risk factors for recurrence, whereas stage greater than I and yolk sac histology are independent poor prognostic indicators.

*Gynecology Department, IRCCS San Raffaele Hospital, Milan; †Procreative Medicine Department, Pisa University, Pisa; ‡Gynecologic Oncology Unit, Department of Gynecology, Obstetrics and Neonatology, University of Bari, Bari; §Obstetrics and Gynecology Department, Cannizzaro Hospital, Catania; ∥Gynecology Department, IRCCS Foundation Policlinico San Matteo, Pavia; ¶Gynecologic Oncology Department, Catholic University of the Sacred Heart, Campobasso; #Gynecologic Oncology Department, National Cancer Institute, Naples; and **Gynecologic Oncology Unit, Catholic University of the Sacred Heart, Rome, Italy.

Received March 22, 2011, and in revised form April 22, 2011.

Accepted for publication May 8, 2011.

Address correspondence and reprint requests to Giorgia Mangili, MD, Gynecology Department, IRCCS San Raffaele Hospital, Via Olgettina, 60, 20132 Milan, Italy. E-mail:

The authors have no conflicts of interest to declare.

Copyright © 2011 by IGCS and ESGO