title: Outcome and prognostic factors in ovarian germ cell malignancies.
abstract: OBJECTIVE
  This study was undertaken to investigate the outcome and prognostic factors in patients with ovarian germ cell malignancies (OGCMs).
  
  
  METHODS
  A total of 93 patients with OGCMs were retrospectively reviewed, among whom 84 patients had primary treatment at Chang Gung Memorial Hospital (CGMH) between 1984 and 2003. The other nine patients were primarily treated outside and referred for follow-up (n = 1), adjuvant chemotherapy (n = 4), or salvage therapy after recurrence (n = 4). The clinicopathological and treatment-related characteristics were analyzed for association with the occurrence of tumor persistence/recurrence or death.
  
  
  RESULTS
  Of the study patients, 32 had dysgerminoma (DSG), 29 immature teratoma (IMT), 23 endodermal sinus tumor, 7 mixed germ cell tumors, and 1 each had choriocarcinoma and embryonal carcinoma. The median follow-up of survivors was 66 months (range, 12-236 months). The median time to recurrence or progression was 8 months. There were 11 treatment failures with 6 died of cancer. The 5-year survival rate was 97.4% for those primarily treated at CGMH. Histology (DSG/IMT versus non-DSG/IMT) (P < 0.0001) and International Federation of Gynecology and Obstetrics stage (P = 0.001) were significantly associated with treatment failure, while histology (P = 0.0004), salvage high-dose chemotherapy (HD-CT) after primary chemotherapy failed (P = 0.0405), and residual tumor after salvage surgery (P = 0.0014) were significant prognostic factors for overall survival.
  
  
  CONCLUSIONS
  Prognosis of OGCMs is excellent if managed with standard treatment initially. Aggressive HD-CT with salvage surgery needs to be applied for recurrent/persistent disease after primary chemotherapy.
authors.affiliation: Department of Obstetrics and Gynecology, Division of Gynecologic Oncology, Chang Gung Memorial Hospital Linkou Medical Center, 5 Fu-Shin Street, Kueishan, Taoyuan 333, Taiwan. sh46erry@ms6.hinet.net
authors.forename: Chyong-Huey
authors.initials: CH
authors.lastname: Lai
authors.forename: Ting-Chang
authors.initials: TC
authors.lastname: Chang
authors.forename: Swei
authors.initials: S
authors.lastname: Hsueh
authors.forename: Tzu-I
authors.initials: TI
authors.lastname: Wu
authors.forename: Angel
authors.initials: A
authors.lastname: Chao
authors.forename: Hung-Hsueh
authors.initials: HH
authors.lastname: Chou
authors.forename: Po-Nan
authors.initials: PN
authors.lastname: Wang
mesh_terms: D000293:Adolescent; D000328:Adult; D017024:Chemotherapy, Adjuvant; D002648:Child; D005260:Female; D006801:Humans; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000628:therapy; D009367:Neoplasm Staging; D009373:Neoplasms, Germ Cell and Embryonal / Q000188:drug therapy / Q000473:pathology* / Q000601:surgery / Q000628:therapy*; D010051:Ovarian Neoplasms / Q000188:drug therapy / Q000473:pathology* / Q000601:surgery / Q000628:therapy*; D011379:Prognosis; D012189:Retrospective Studies; D016879:Salvage Therapy; D016896:Treatment Outcome