Article Text
Abstract
Introduction Somatic malignancies arising in teratoma(SMT) in ovarian GCT are rare, there is sparse data available globally. We studied factors influencing survival.
Methods This was a retrospective review of EMR between 2013-2022. Overall and progression free survivals were calculated by Kaplan-Meier method. Cox proportional hazards model was performed to identify factors affecting survival.
Results The study included 34 cases, median age was 51years. SMT arose on a background of mature teratoma in 85%(29/34) and immature teratoma in 15%(5/34). Squamous cell carcinoma(SCC) was most the common SMT(50%;17/34), followed by adenocarcinoma(17.64%;6/34) and others(32.3%;11/34). SMT was detected in recurrent setting in 14.7%(5/34). Non-teratomatous germ cell components seen in 11.8%(4/34). Appropriate cytoreductive/staging surgery performed in 47%(16/34), fertility sparing surgery in 17.6%(6/34). Residual disease was present in 23.5%(8/34). Stage-wise distribution was equal between early(I/II) and advanced stages(III/IV); (47%;16/34 each). Adjuvant chemotherapy administered in 50%(17/34). At median follow-up of 56 months, 26.4%(9/34) patients died of the disease; 8.8%(3/34) were alive with disease. OS and PFS at 4.5years was 59.4%(95%CI:41.5-85.1) and 56%(95%CI:39.5-79.2), respectively (figure 1). On univariate analysis, residual disease and presence of additional non-teratomatous germ cell components were significant poor prognostic factors for OS & PFS, additionally for PFS, detection of SMT at recurrence was significant; histopathology of SMT (SCC vs others), adjuvant treatment were not statistically significant prognostic factors for both OS and PFS. On multivariate analysis, residual disease remained statistically significant (table 1).
Conclusion/Implications Complete surgical resection is crucial for better survival in SMT. The role of adjuvant systemic therapy after complete resection warrants further investigation.