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Surveillance alone in stage I malignant ovarian germ cell tumors: a MITO (Multicenter Italian Trials in Ovarian cancer) prospective observational study
  1. Giorgia Mangili1,
  2. Giorgio Giorda2,
  3. Gabriella Ferrandina3,4,
  4. Gennaro Cormio5,
  5. Chiara Cassani6,
  6. Antonella Savarese7,
  7. Saverio Danese8,
  8. Marco Carnelli9,
  9. Francesca Maria Vasta1,
  10. Anna Myriam Perrone10,
  11. Giovanna Scarfone11,
  12. Sandro Pignata12,
  13. Francesco Legge13,
  14. Francesco Raspagliesi14,
  15. Gianluca Taccagni15,
  16. Massimo Candiani1,16,
  17. Giorgio Bogani17,
  18. Floriana Mascilini3 and
  19. Alice Bergamini1
  1. 1Department of Obstetrics and Gynecology, IRCCS Ospedale San Raffaele, Milano, Italy
  2. 2Centro di Riferimento Oncologico di Aviano, IRCCS Aviano, Aviano, Italy
  3. 3Dipartimento per la Salute della Donna e del Bambino e della Salute Pubblica, Policlinico Universitario Agostino Gemelli, Roma, Italy
  4. 4Università Cattolica del Sacro Cuore Sede di Roma, Roma, Italy
  5. 5Gynecologic Oncology Unit, University of Bari, Bari, Italy
  6. 6Department of Obstetrics and Gynaecology, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
  7. 7Division of Medical Oncology 1, Regina Elena Institute, Roma, Italy
  8. 8Deparment of Obstetrics and Gynecology, Azienda Ospedaliero Universitaria Città della Salute e della Scienza di Torino, Torino, Italy
  9. 9Unit of Gynecology and Obstetrics, Azienda Ospedaliera Papa Giovanni XXIII, Bergamo, Italy
  10. 10IRCCS Azienda Ospedaliero-Universitaria di Bologna Policlinico S Orsola-Malpighi, Bologna, Italy
  11. 11Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico Mangiagalli Center, Milano, Italy
  12. 12Uro-Gynecological Department, Istituto Nazionale per lo Studio e la Cura dei Tumori, Fondazione "G. Pascale", Naples, Italy
  13. 13Ospedale Generale Regionale F Miulli, Acquaviva delle Fonti, Puglia, Italy
  14. 14Surgery, Fondazione IRCCS Istituto Nazionale dei Tumori, Milano, Italy
  15. 15Department of Pathology, IRCCS Ospedale San Raffaele, Milano, Italy
  16. 16Università Vita Salute San Raffaele, Milano, Italy
  17. 17Department of Gynecologic Oncology, Fondazione IRCCS Istituto Nazionale dei Tumori, Milano, Italy
  1. Correspondence to Dr Alice Bergamini, Department of Obstetrics and Gynecology, IRCCS Ospedale San Raffaele, Milano 20132, Italy; bergamini.alice{at}


Objective The aim of this study was to analyze the oncological outcome of stage I malignant ovarian germ cell tumors patients included in the MITO-9 study to identify those who might be recommended routine surveillance alone after complete surgical staging.

Methods MITO-9 was a prospective observational study analyzing data collected between January 2013 and December 2019. Three groups were identified: group A included 13 patients stage IA dysgerminoma and IAG1 immature teratoma; group B included 29 patients with stage IB–C dysgerminomas, IA–C G2–G3 immature teratomas and stage IA mixed malignant ovarian germ cell tumors and yolk sac tumors; and group C included five patients (two patients with stage IC1 and one patient with stage IC2 yolk sac tumors and two patients with mixed-stage IC2 malignant ovarian germ cell tumors).

Results A total of 47 patients with stage I conservatively treated malignant ovarian germ cell tumors were analyzed. Two patients in group B were excluded from the routine surveillance alone group due to positive surgical restaging. Therefore, a total of 45 patients were included in the study. Median follow-up was 46.2 months (range; 6–83). In total, 14 of 45 patients (31.1%) received chemotherapy, while 31 (68.9%%) underwent surveillance alone. One patient in group A, with stage IA dysgerminoma had a relapse, successfully managed with conservative surgery and chemotherapy. None of the patients in group B and C relapsed. All patients were alive at completion of the study. Overall, among 31 patients (68.9%) who underwent surveillance alone, only one patient relapsed but was treated successfully.

Conclusions Our data showed that close surveillance alone could be an alternative option to avoid adjuvant chemotherapy in properly staged IB–C dysgerminomas, IA–IC G2–G3 immature teratomas, and IA mixed malignant ovarian germ cell tumors with yolk sac tumor component.

  • ovarian cancer
  • surgical oncology
  • medical oncology

Data availability statement

All data relevant to the study are included in the article or uploaded as supplemental information.

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Data availability statement

All data relevant to the study are included in the article or uploaded as supplemental information.

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  • Contributors GM, AB, GC, SP study design. All authors data collection. AB statistical analysis. AB, GM, FV manuscript draft. All authors manuscript review and approval of final version.

  • 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.

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