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Oral Sessions
06. Ovarian cancer
#872 Malignant ovarian germ cell tumours: an international multicentre study to identify new prognostic risk factors
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  1. Suyanto Suyanto1,
  2. Alice Bergamini2,
  3. Constantinos Savva3,
  4. Baljeet Kaur4,
  5. Srdjan Saso1,
  6. Christina Fotopoulou1,
  7. Naveed Sarwar1,
  8. Adrian Lim1,
  9. Gordon Rustin5,
  10. Anand Sharma5,
  11. Marcia Hall5,
  12. Andrew Gogbashian6,
  13. Cristina Angela Camnasio7,
  14. Sophie Merrick8,
  15. Chiara Cassani9,
  16. Sandro Pignata10,
  17. Cormio Gennaro11,
  18. Gabriella Ferrandina12,
  19. Giovanna Scarfone13,
  20. Giorgia Mangili14 and
  21. Michael Seckl15
  1. 1Imperial College Healthcare NHS Trust, London, UK
  2. 2Unit of Obstetrics and Gynaecology, IRCCS San Raffaele Scientific Institute; Faculty of Medicine and Surgery, Vita-Salute San Raffaele University, Milano, Italy
  3. 3University of Southampton, Southampton, UK
  4. 4North West London Pathology, Imperial College Healthcare NHS Trust, London, UK
  5. 5Mount Vernon Cancer Centre, Northwood, UK
  6. 6Paul Strickland Scanner Centre, Mount Vernon Cancer Centre, Northwood, UK
  7. 7IRCCS Policlinico San Matteo Pavia, Pavia, Italy
  8. 8MRC Clinical Trials Unit, University College London, London, UK
  9. 9Department of Clinical, Surgical, Diagnostic and Pediatric Sciences, University of Pavia, Pavia, Italy
  10. 10Department of Urology and Gynecology, Istituto Nazionale Tumori IRCCS Fondazione G. Pascale, Napoli, Italy
  11. 11Gynecologic Oncology Istituto Tumori Giovanni Paolo II – IRCCS, University of Bari, Bari, Italy
  12. 12OC Ginecologia Oncologica, Dipartimento Scienze della Salute della Donna e del Bambino, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Roma, Italy
  13. 13Gynecology Unit, Fondazione IRCCS Ca’ Granda-Ospedale Maggiore Policlinico, Milan, Italy
  14. 14Unit of Obstetrics and Gynaecology, IRCCS San Raffaele Scientific Institute, Milan, Italy
  15. 15Imperial College London, London, UK

Abstract

Introduction/Background Malignant ovarian germ cell tumours (MOGCTs) are rare and aggressive malignancies mainly affecting young women. Unlike testicular GCTs, prognostic factors are poorly understood, but small series have most consistently suggested that advanced stage best predicts worse outcomes. Here, we examine a large, international patient series to identify new adverse prognostic factors.

Methodology We evaluated 254 patients treated in Charing Cross Hospital and Mount Vernon Cancer Centre, UK and in Multi-centre Italian Trials in Ovarian Cancer (MITO) group between 1971 and 2018. Descriptive statistical, survival and Cox regression techniques were performed using STATA (StataCorp, v.16, Texas, USA).

Results Median age was 26 years (IQR, 20–32). There were 22.4% dysgerminomas, 18.5% immature teratomas, 33.5% yolk sac, 17.7% mixed, 1.2% embryonal, 2.4% choriocarcinoma and 4.3% unclassified. FIGO stage distribution was 31.5% (IC/M), 12.6% (II), 40.5% (III) and 15.4% (IV). First line chemotherapy consisted of BEP, POMB/ACE or other regimens for 48.0%, 42.5% and 9.5% of patients, respectively. Recurrences received high dose chemotherapy (HDCT), conventional chemotherapy ± surgery, and surgery alone in 24.4%, 65.9% and 7.3% of cases.

At multivariable analysis, age ≥35 at presentation [HR 2.3, 95%CI (1.0–5.0), p=0.04], stage [HR 1.5, 95%CI (1.0–2.1), p=0.032], and non-dysgerminoma versus dysgerminoma [HR 12.7, 95%CI (1.7–94.0), p=0.013] were significantly associated with worse cancer-specific survival (CSS). Twenty-year CSS for stage IC/M, II, III, and IV were 94.8%, 82.3%, 83.2% and 84.3%, respectively. In patients relapsing or failing to achieve a complete response, HDCT showed a trend for improved 5-year CSS compared to conventional treatments [HR 0.5, 95%CI (0.2–1.5), p=0.241].

Conclusion This study demonstrated that in addition to advanced stage, age ≥35 years, and non-dysgerminoma, but not immature teratomas, are independent adverse prognostic factors for CSS. Strikingly, stage IV disease can still achieve >80% long-term survival rates. HDCT may improve outcomes for relapsing/incomplete responding patients.

https://doi.org/10.1136/ijgc-2023-ESGO.42

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