Long-term outcome and prognostic factors in 80 women treated for ovarian yolk sac tumor
Authors: T. de La Motte Rouge, P. Pautier, P. Duvillard, A. Rey, P. Morice, C. Haie-Meder, P. Kerbrat, S. Culine, F. Troalen, C. Lhommé
Journal: Journal of Clinical Oncology (2008)

5547 Background: Ovarian yolk sac tumor (YST) is a very rare malignancy arising in young women. Due to the rarity of this tumor, only few retrospective series have been published. Our study was aimed to evaluate the long-term outcome and to identify prognostics parameters, which might help to make appropriate risk-based decision about therapy. Methods: This retrospective study is based on prospectively recorded ovarian YST cases at the Institut Gustave-Roussy. Pediatric cases were excluded. Survival curves were estimated by the Kaplan-Meier method. Univariate analysis using the log-rank test tested possible associations between survival and patient (pt) or disease covariates. Multivariate analysis was performed using a model of logistic regression including age, stage (FIGO), presence of ascites at diagnosis, and chemotherapy regimen. Results: Between 1976 and 2006, 80 pts were registered. Median post operative AFP was 1,700 (2 - 154,000) ng/mL. Since 1991, most of the pts have undergone fertility-sparing surgery. Cisplatin-based chemotherapy was given in 75 pts. Among them, 47 received bleomycin, etoposide and cisplatin (BEP) regimen. With a median follow-up of 71 months, the overall 5-year and event-free survival rates were 83% and 78%, respectively. No relapses occurred > 12 months following the end of treatment. The table lists the results of univariate analysis. In the multivariate model only the age < 30 years and absence of ascites at initial diagnosis were significantly associated with a better overall survival, although a strong trend was observed with BEP regimen (p = 0.06). Conclusions: Fertility-sparing surgery followed with BEP chemotherapy allow a high curability rate for pts with ovarian YST, and should be the standard of care. Several factors were correlated with a good prognosis. Although further study is warranted, this might help to select pts for risk-adapted treatment, especially since the issue of surveillance instead of adjuvant chemotherapy has been raised for stage Ia ovarian germ cell tumors. Univariate analysis No. of patients % 5-year EFS (95% CI) p* % 5-year OS (95% CI) p* Ovarian YST Pure 47 71% (55%-82%) NS 79% (65%-89%) NS Mixed 33 88% (73%-95%) 88% (72%-95%) Age (years) < 30 61 85% (74%-92%) 0.005 88% (77%-94%) 0.03 ≥ 30 19 58% (36%-77%) 69% (51%-82%) Stage I 37 89% (74%-95%) 0.02 94% (81%-98%) 0.01 II,III,IV 43 69% (54%-81%) 75% (59%-86%) Ascites at diagnosis Absence 52 88% (76%- 94%) 0.004 93% (82%-98%) 0.0007 Presence 28 61% (42%-76%) 64% (45%- 79%) Hepatoid aspect No 65 83% (72%- 90%) 0.09 84% (73%-91%) NS Yes 15 58% (33%-79%) 79% (52%- 92%) Fertility-sparing surgery No 28 71% (52%- 85%) 0.07 78% (60%-90%) NS Yes 51 84% (71%-92%) 88% (76%- 94%) Postoperative AFP (ng/mL) < 1000 30 93% (78%-98%) 0.03 97% (83%-99%) 0.03 ≥ 1000 42 71% (56%-82%) 75% (59%-86%) Time to AFP normalization during chemotherapy (days) ≤ 50 36 94% (82%-99% 0.01 94% (81%- 98%) 0.05 > 50 33 ) 69% (52%-82%) 77% (59%-88%) * log rank test No significant financial relationships to disclose.