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Advanced ovarian yolk sac tumor: upfront surgery or neoadjuvant chemotherapy followed by interval debulking?
  1. Xinyue Zhang1,2,
  2. Jie Yang1,2,
  3. Yang Xiang1,2,
  4. Lingya Pan1,2,
  5. Ming Wu1,2,
  6. Dongyan Cao1,2 and
  7. Jiaxin Yang1,2
  1. 1Department of Obstetrics and Gynecology, Peking Union Medical College Hospital, Beijing, China
  2. 2National Clinical Research Center for Obstetric & Gynecologic Diseases, Beijing, China
  1. Correspondence to Dr Jie Yang, Department of Obstetrics and Gynecology, Peking Union Medical College Hospital, Beijing, Beijing, 100730, China; yangjie56{at}


Objective To compare surgery and survival outcomes between neoadjuvant chemotherapy and primary debulking surgery in patients with advanced ovarian yolk sac tumor.

Methods In this retrospective cohort analysis, patients with stage III to IV ovarian yolk sac tumor or mixed germ cell tumors containing yolk sac tumor elements, and who underwent surgery at Peking Union Medical College Hospital between January 2011 and December 2021, were identified. Patient characteristics, treatment, and survival data were analyzed between the two groups.

Results A total of 40 patients were enrolled: 19 patients received neoadjuvant chemotherapy followed by interval surgery, and 21 patients were treated with primary debulking surgery. After neoadjuvant chemotherapy, the surgical conditions of patients were improved. All patients achieved cytoreduction to R0 or R1 at interval surgery. No statistical difference was found in 3-year disease-free survival and overall survival between the neoadjuvant chemotherapy group and the primary debulking surgery group (log rank p=0.4 and 0.94). Patients had less blood loss (328.4 vs 1285.7 mL, p=0.029), lower transfusion volume (1044.4 vs 3066.7 mL, p=0.011), and fewer peri-operative complications (15.8% vs 47.6%, p=0.032) at the interval debulking surgery after neoadjuvant chemotherapy compared with patients who underwent primary debulking surgery.

Conclusion For patients with advanced-stage ovarian yolk sac tumor, neoadjuvant chemotherapy followed by interval surgery is an alternative option, especially for those who cannot tolerate the primary debulking surgery because of high tumor burden and vulnerable status.

  • Genital Neoplasms, Female
  • Ovarian Cancer
  • Surgery
  • Cytoreduction surgical procedures

Data availability statement

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

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Data availability statement

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

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  • Contributors Conception and study design: XZ, JY, JY. Provision of study material or patients: JY, YX, LP, MW, DC. Data collection and interpretation: XZ, JY. Statistical analysis: XZ, JY. Manuscript preparation: XZ, JY. Final approval of manuscript: all authors. Accountable for all aspects of the work: all authors. Guarantor: XZ, JY.

  • Funding This study was supported by the Chinese Academy of Medical Sciences Innovation Fund for Medical Sciences (CIFMS) (2022-I2M-C&T-B-023), National High Level Hospital Clinical Research Funding (2022-PUMCH-B-083), National Key Research and Development Program of China (2022YFC2704202).

  • Competing interests None declared.

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

  • Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.