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Ovarian Yolk Sac Tumors; Does Age Matter?
  1. Cecile Faure Conter, MD*,
  2. Caihong Xia, MD,
  3. David Gershenson, MD,
  4. Jean Hurteau, MD§,
  5. Al Covens, MD,
  6. Farzana Pashankar, MD,
  7. Mark Krailo, MD#,
  8. Deborah Billmire, MD**,
  9. Catherine Patte, MD,,
  10. Brice Fresneau, MD,,
  11. Furqan Shaikh, MD,,
  12. Sara Stoneham, MD§§,
  13. James Nicholson, MD∥∥,
  14. Matthew Murray, MD∥∥ and
  15. Anne Lindsay Frazier, MD¶¶
  1. * Institute of Pediatric Hematology and Oncology, Lyon, France;
  2. Children’s Oncology Group, Monrovia, CA;
  3. University of Texas MD Anderson Cancer Center, Houston, TX;
  4. § University of Chicago Pritzker School of Medicine, North Shore University Health System, Evanston, IL;
  5. University of Toronto, Sunnybrook Health Sciences Center, Ontario, Canada;
  6. Yale university, New Haven, CT;
  7. # University of Southern California, Los Angeles, CA;
  8. ** Riley Hospital for Children, Indianapolis, IN;
  9. †† Department of Pediatric Oncology, Gustave Roussy, Université Paris-Saclay Villejuif, France;
  10. ‡‡ Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada;
  11. §§ Children’s and Young Persons Cancer Services, University College London Hospital Trusts, London, United Kingdom;
  12. ∥∥ Department of Paediatric Haematology and Oncology, Cambridge University Hospitals NHS Foundation Trust, Cambridge, United Kingdom; and
  13. ¶¶ Dana-Farber/Boston Children’s Cancer and Blood Disorders Center, Boston, MA.
  1. Address correspondence and reprint requests to Cécile Faure-Conter, MD, Institute of Pediatric Hematology and Oncology, 1 Place Joseph Renault, 69008 Lyon, France. E-mail: cecile.conter{at}


Background Whereas among pediatric oncologists, ovarian yolk sac tumor (O-YST) is considered a chemosensitive tumor, it is often cited as an adverse prognostic factor in adult women with ovarian germ cell tumors.

Methods The Malignant Germ Cell International Consortium data set included 6 pediatric clinical trials (United States, United Kingdom, and France) and 2 adult gynecology clinical trials (United States). Any patient with an O-YST that was International Federation of Gynecology and Obstetrics stage IC or higher and treated with a platinum-based chemotherapy was eligible. Age was modeled as a continuous and a categorical variable (children, 0-10 years; adolescents, 11–17 years; and adults, ≥18 years). In addition, analyses to establish the optimal cut point for age were conducted. Tumors were coded as pure YST (YST +/− teratoma), mixed YST (YST + other malignant germ cell component), or putative YST (“mixed” germ cell tumor + alpha-fetoprotein >1000 ng/mL). Histology, stage (II/III vs IV), preoperative alpha-fetoprotein levels (<1000; 1000–10,000, or >10,000 ng/mL), and chemotherapeutic regimen (carboplatin vs cisplatin) were analyzed as covariates.

Results Two hundred fifty-one patients (median age, 13 years; range, 0–38 years) were identified (78 children, 139 adolescents, and 34 adults). Histology was pure, mixed, and putative in 129, 56, and 66 cases, respectively. Twenty-six patients had stage IV disease, similarly distributed in the 3 age groups. Median follow-up was 5.8 years. The overall 5-year event-free survival and overall survival was 91% (95% confidence interval, 87%–94%) and 96% (92%–98%), respectively. Age did not affect risk of event or death, modeled either as a categorical or continuous variable. Analysis failed to identify an age cut point that affected risk. None of the other covariates investigated had a prognostic impact on event-free survival or overall survival.

Conclusions Ovarian yolk sac tumors have an excellent outcome across all age-groups. Age has no apparent impact on the probability of event or death, allowing pediatric and gynecologic oncologists to enroll patients onto joint pediatric and adult trials.

  • Malignant ovarian germ cell tumor
  • Yolk sac tumor
  • Chemotherapy
  • Ovarian cancer
  • Age
  • Prognostic

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