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Comparison of overall and patterns of care in patients with a malignant ovarian germ cell tumor by age in the United States: a National Cancer Database (2004–2016) analysis
  1. Shannon M Sullivan1,2,
  2. Sara Stoneham3,
  3. Michelle Lockley4,5,
  4. A. Lindsay Frazier6,
  5. Deborah F Billmire7 and
  6. Jenny N Poynter1,8
    1. 1Department of Pediatrics, University of Minnesota Twin Cities, Minneapolis, Minnesota, USA
    2. 2Department of Laboratory Medicine and Pathology, University of Minnesota Twin Cities, Minneapolis, Minnesota, USA
    3. 3Department of Paediatric Oncology, University College London Hospitals NHS Foundation Trust, London, UK
    4. 4Centre for Cancer Genomics and Computational Biology, Barts Cancer Institute, Queen Mary University of London, London, UK
    5. 5Department of Gynaecological Oncology, Cancer Services, University College London Hospitals NHS Foundation Trust, London, UK
    6. 6Dana-Farber/Boston Children's Cancer and Blood Disorders Center, Boston, Massachusetts, USA
    7. 7Department of Pediatric Surgery, Riley Hospital for Children, Indianapolis, Indiana, USA
    8. 8University of Minnesota Masonic Cancer Center, Minneapolis, Minnesota, USA
    1. Correspondence to Dr Jenny N Poynter, Department of Pediatrics, University of Minnesota Twin Cities, Minneapolis, MN 55455, USA; poynt006{at}umn.edu

    Abstract

    Background Women aged ≥40 years diagnosed with a malignant ovarian germ cell tumor are more likely to have poor outcomes than their younger counterparts (aged 15–39 years).

    Objective We used the National Cancer Database (NCDB) to evaluate patterns of care and overall survival for individuals diagnosed with one of the four most common histologic subtypes of malignant ovarian germ cell tumor by age group.

    Methods We identified women aged 15–90 diagnosed with ovarian germ cell tumors in the NCDB (2004–2016). Logistic regression was used to compare patterns of care, demographic, and disease characteristics by age group. Cox proportional hazards regression was used to evaluate associations between a range of demographic, clinical, and treatment characteristics with overall survival.

    Results A total of n=2998 patients who were diagnosed with one of the four most common histologic subtypes (immature teratoma, dysgerminoma, yolk sac tumor, and mixed germ cell) of ovarian germ cell tumor were included in the analysis. Patients aged ≥40 years diagnosed with ovarian germ cell tumors were more likely to have co-morbidities, a bilateral tumor, higher stage of disease, receive chemotherapy only, and have a residual tumor after resection as compared with patients aged <40 years. Moreover, women aged ≥40 years had the highest risk of death (reference: 15–24 year olds; HR=5.37, 95% CI 3.76 to 7.66) after adjustment for demographic characteristics, tumor histology, and treatment received. In stratified analyses, women aged ≥40 years had significantly worse overall survival at each disease stage and histologic subtype.

    Conclusion Findings suggest that women aged ≥40 years who are diagnosed with ovarian germ cell tumors have worse overall survival than those aged <40, independent of stage, disease characteristics, and treatment. Our study highlights the need for future research to better understand reasons for poorer outcomes in women aged ≥40 years.

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    Data availability statement

    Data may be obtained from a third party and are not publicly available. This manuscript uses data from the National Cancer Database (NCDB). NCDB participant user files are only available through an application process to investigators associated with Commission on Cancer-accredited cancer programs.

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    Data availability statement

    Data may be obtained from a third party and are not publicly available. This manuscript uses data from the National Cancer Database (NCDB). NCDB participant user files are only available through an application process to investigators associated with Commission on Cancer-accredited cancer programs.

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    Footnotes

    • X @CiganSullivan

    • Contributors SMS wrote the statistical analysis plan, cleaned and analyzed the data, and drafted and revised the manuscript. She is responsible for the overall content as a guarantor. SS, ML, LF, DFB, and JNP were all responsible for initiating the collaborative project including planning the study and writing the ancillary study proposal. JNP is responsible for gaining access to the data, providing resources, supervision, and writing the original draft. SS, ML, LF, DFB, and JNP provided feedback on the analytical results and revised the draft manuscript.

    • Funding This study was supported by funds from the Children’s Cancer Research Fund, Minneapolis, Minnesota.

    • Competing interests LF has acted as a paid consultant for Decibel Therapeutics for work performed outside of the current study.

    • 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.