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Role of optimal cytoreduction in patients with dysgerminoma
  1. Antonio Bandala-Jacques1,2,
  2. Fabiola Estrada-Rivera1,2,
  3. David Cantu1,
  4. Diddier Prada2,3,
  5. Gonzalo Montalvo-Esquivel1,
  6. Aarón González-Enciso4 and
  7. Salim Abraham Barquet-Munoz1
  1. 1Departamento de Ginecología, Instituto Nacional de Cancerología, Mexico City, Mexico
  2. 2Unidad de Investigación Biomédica en Cáncer, Instituto Nacional de Cancerología, Mexico City, Mexico
  3. 3Departamento de Informática Biomédica, Facultad de Medicina, Universidad Nacional Autonoma de Mexico, Mexico City, Mexico
  4. 4Departamento de Cirugía, Instituto Nacional de Cancerología, Mexico City, Mexico
  1. Correspondence to Dr Salim Abraham Barquet-Munoz, Departamento de Ginecología, Instituto Nacional de Cancerología, 14080 Mexico City, Mexico; sbarquet{at}gmail.com

Abstract

Background Dysgerminomas are malignant ovarian germ-cell tumors that typically affect young women. Although these tumors have an excellent response to chemotherapy, surgery is an integral part of primary treatment.

Objective To evaluate outcomes of initial cytoreduction in patients diagnosed with dysgerminomas.

Methods Patients who underwent primary cytoreductive surgery for ovarian dysgerminoma between January 1985 and December 2013 were identified and included in the study. A comparison was made between patients who underwent optimal versus sub-optimal cytoreduction. Descriptive, comparative statistics and odds ratios were used to establish an association. Survival curves were performed with the Kaplan-Meier method and compared using a log-rank test. A value of p<0.05 was used to establish a statistical difference.

Results A total of 180 patients with a histologically confirmed dysgerminoma were included in the analysis. A subsection of 37 patients in stages III/IV were analyzed. The median age at diagnosis was 21 years (IQR 18–26). Histologically, 166 (92.2%) patients had pure dysgerminomas, whereas the rest had mixed histologies. The median tumor size was 18 (IQR 12–22) cm. In all stages, factors associated with optimal cytoreduction, were higher lactate dehydrogenase levels (OR=1.01; p=0.03), higher CA125 levels (OR=1.01; p=0.04), receiving adjuvant chemotherapy (OR=0.22; p<0.01), or undergoing treatment in a specialized institution (OR=12.68; p<0.01). Patients in stages III/IV, initially managed outside our institution were less likely to be taken for cytoreduction (OR=16.88; p=0.013). Other factors, including age (OR=1.02; p=0.39), pelvic lymph-node positivity (OR=2.24; p=0.36), pregnancy during follow-up (OR=0.91: p=0.80), or recurrence of disease (OR=1.93; p=0.23) were found to be similar in both groups. Overall survival was higher in optimally cytoreducted patients (100% vs 95.7%; p=0.032) including all stages, but not if considering only stages III/IV (100% vs 90%, p=0.186); disease-free survival was the same for both groups regardless of stage (94.3% vs 91.1%; p=0.36).

Conclusion Patients with optimal surgeries were most likely to be treated in referral centers. Initial residual disease did not significantly alter recurrence, progression, disease-free survival, or overall survival.

  • ovarian neoplasms
  • surgical oncology
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Footnotes

  • AB-J and FE-R contributed equally.

  • Contributors ABJ: performed the analysis; wrote the paper; contributed to translation of the tables and data. FE-R: conceived and designed the analysis; collected data. DC, DP, GM-E, AG-E: reviewed the analysis; corrected the manuscript. SAB-M: collected the data; performed the analysis; contributed the analysis tool

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Patient consent for publication Not required.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data availability statement No data are available.

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