Clinical Retrospective Analysis Of 102 Patients With Stage Ⅰ Malignant Ovarian Germ Cell Tumors

ObjectiveThrough retrospective case analysis,we summarized the clinicopathological characteristics of patients with stage I malignant ovarian germ cell tumors(MOGCTs),and explored the related factors that affect the survival rates and reproductive outcomes.MethodsThe clinical case data of 102 patients with stage I MOGCTs who were admitted to Qilu Hospital of Shandong University from May 2003 to August 2020 were collected and compiled by searching the inpatient and outpatient case databases and telephone follow-ups.Then we summarized the clinicopathological characteristics of the patients,and explored the related factors that affect the survival rates and reproductive outcomes through retrospective statistical analysis.Results1.Among 102 patients with stage I MOGCTs,the median age at the time of surgery was 24.5 years(range 2-81 years).Most of the patients showed abdominal pains(42 cases,41.2%),abdominal distensions(28 cases,27.5%),and some patients had no obvious clinical symptoms(21 cases,20.6%).2.The histopathological types of 102 patients with stage I MOGCTs were:49 cases of immature teratomas(48.0%),seven cases of malignant transformation of mature teratomas(6.9%),seven cases of mixed germ cell tumors(6.9%),14 cases(13.7%)of yolk sac tumors,25 cases(24.5%)of dysgerminomas.Among them,72 cases(70.6%)were in stage IA,one case was in stage IB(1.0%),seven cases were in stage IC1(6.9%),21 cases were in stage IC2(20.6%),and one case was in stage IC3(1.0%).3.All 102 patients received surgical treatments.88 cases(86.3%)underwent fertility sparing surgeries(FSS),and 14 cases(13.7%)did not.39 cases underwent comprehensive staging surgeries(CSS)(38.2%),and 63 cases(61.8%)did not.10 cases(9.8%)underwent simple unilateral ovarian tumor resections,and 14 cases(13.7%)underwent simple unilateral adnexectomies.39 cases(38.2%)underwent retroperitoneal lymph node biopsies/dissections.Of the 102 patients,13 cases received only surgical treatments,84 cases received surgical treatments and postoperative adjuvant chemotherapies,and five cases’postoperative adjuvant treatments were unknown.4.The follow-up time was 4 to 197 months.Three cases of immature teratomas recurred,two of which were recurred only with mature teratomas;One case of mixed germ cell tumors was recurred only with mature teratoma component;One case suffered from heterogeneous MOGCT after operation.One patient with mixed germ cell tumor failed to rescue after recurrence and eventually died;One patient with malignant transformation of immature teratoma was uncontrolled or relapsed and eventually died;The cause of death in one patient with immature teratoma was unknown.The 3-year progression free survival(PFS)was 92.7%,the 5-year cumulative PFS was 90.8%,and the 3-year and 5-year cumulative overall survival(OS)were 97.5%.Among the 40 patients with fertility requirements,19 cases(47.5%)were successfully given birth after the operation,and three patients were in pregnancy at the follow-up(two of them had successfully given birth to one offspring).One person experienced two spontaneous abortions,one case underwent an abortion due to an unplanned pregnancy.5.Univariate analysis shows:for PFS,age<20 and≥20 years old(p=0.036),mixed germ cell tumors and non-mixed germ cell tumors(p=0.017),Whether to receive chemotherapy for patients whose guidelines recommend not receiving chemotherapy(p=0.018)have significant difference in PFS,but whether it contains yolk sac tumor components,IA-IB stage and IC stage,whether AFP is elevated before operation,whether HCG is elevated before operation,whether to perform FSS,Whether to perform CSS,BEP chemotherapy regimen and other chemotherapy regimens,BEP/BEC/EP chemotherapy regimens and other chemotherapy regimens have no significant difference in PFS.For OS,only mixed germ cell tumors and non-mixed germ cell tumors(p=0.028)have a statistically significant difference.In the multivariate analysis of age<20 and≥20 years old,mixed germ cell tumors and non-mixed germ cell tumors,there is a statistical difference in PFS between mixed germ cell tumors and non-mixed germ cell tumors(HR:9.327,95%CI:1.761-49.411,p=0.009),but for patients whose guidelines recommend not receiving chemotherapy,multivariate analysis shows no statistically significant difference in PFS between germ cell tumors and non-mixed germ cell tumors.In addition,multivariate analysis shows that only the difference in OS between mixed germ cell tumors and non-mixed germ cell tumors(HR:13.297,95%CI:1.056-167.397,p=0.045)is statistically significant.6.For patients with stage I MOGCTs who have fertility requirements,there are no statistical differences in pregnancy rates and live birth rates between different pathological types(p=0.105),stage IA and IC(p=0.071),whether to perform contralateral ovarian dissections/wedge resections/biopsies(p=0.641),whether to perform CSS(p=0.386),whether to undergo postoperative chemotherapies(p=0.770),and whether to use gonadotropin releasing hormone agonists(GnRH-a)during postoperative chemotherapies(p=1.000).Conclusion1.Stage I MOGCTs mostly occur in adolescents and young women of gestational age.2.The prognosis of patients with stage I MOGCTs is good.In addition to mixed germ cell tumors that may be risk factor affecting PFS and OS,age,whether it contains yolk sac tumor components,FIGO stages,whether AFP is elevated,whether HCG is elevated,whether to perform FSS,and whether to perform CSS have no significant effects on PFS and OS of patients with stage I MOGCTs.3.FSS is feasible for young patients with stage I MOGCTs who have fertility requirements,the pathological types,FIGO stages,whether to undergo contralateral ovarian dissections/wedge resections/biopsies,whether to perform CSS,whether to use GnRH-a have no significant influences in pregnancy rates and live birth rates.