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Malignant Ovarian Germ Cell Tumors: Identification of Novel Prognostic Markers and Long-Term Outcome After Multimodality Treatment

Nirupa Murugaesu, Peter Schmid, Gairin Dancey, Roshan Agarwal, Lydia Holden, Iain McNeish, Philip M. Savage, Edward S. Newlands, Gordon J.S. Rustin, Michael J. Seckl

From the Department of Medical Oncology, Charing Cross Hospital, London; and the Mount Vernon Hospital, Middlesex, United Kingdom

Address reprint requests to Michael J. Seckl, FRCP, PhD, Department of Medical Oncology, Charing Cross Hospital, Fulham Palace Rd, London W6 8RF, United Kingdom; e-mail: m.seckl{at}imperial.ac.uk

PURPOSE: Malignant ovarian germ cell tumors are rare and knowledge about prognostic parameters currently is limited. This study was undertaken to evaluate long-term outcome of patients with malignant ovarian germ cell tumors (MOGCTs) after chemotherapy and to assess prognostic parameters.

PATIENTS AND METHODS: A total of 113 patients with stage IC to IV MOGCTs were included into this retrospective study. Patients were treated at two large regional cancer centers between 1977 and 2003.

RESULTS: Ten-year recurrence-free and overall survival rates were 82% and 81%, respectively. A total of 20 patients experienced relapse, all within the first 8 years. Outcome after relapse was poor, with only 10% of patients achieving long-term survival. Univariate and multivariate analyses demonstrated that initial stage of disease (relative risk [RR], 5.96; 95% CI, 3.47 to 10.22; P = .03) and elevation of serum markers ß-human chorionic gonadotropin and alpha-fetoprotein (RR, 3.90; 95% CI, 1.40 to 10.9; P = .009) were significant predictors of overall survival, whereas age at diagnosis was of no prognostic value.

CONCLUSION: This is the first study to identify stage and tumor markers as prognostic parameters for patients with MOGCTs. This might help to select patients for risk-adapted treatment. There is need for improvement of therapeutic strategies after relapse.

N.M. and P.S. contributed equally to this work.

Authors' disclosures of potential conflicts of interest and author contributions are found at the end of this article.

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