The influence of conservative surgical practices for malignant ovarian germ cell tumors.
OBJECTIVE
To evaluate demographics, survival, and surgical trends for patients with malignant ovarian germ cell tumors.


METHODS
SEER data abstracted from 1988 to 2001 and analyzed using Kaplan-Meier and Cox regression models.


RESULTS
Of 760 patients, the median age was 23 years. Seventy-six percent of patients presented with stage I-II disease, and 24% with stage III-IV. Fifty-five percent were immature teratomas, 32% dysgerminomas, and 13% yolk sac tumors. Fertility-preserving surgery was performed in 41.2% (n = 313) of patients. In those <45 years old, the use of fertility-preserving surgery increased from 40.5% to 44.5% to 48.4% over the time periods 1988-1992, 1993-1997, 1998-2001 (P = 0.25). The survival of patients who underwent fertility-preserving surgery was not statistically different compared to those who underwent standard surgery (P = 0.26). Patients with stage I-II disease had improved survival compared to stage III-IV disease (97.6% vs. 85.5%, P < 0.001). The overall survival of women with dysgerminomas, immature teratomas, and yolk sac tumors was 99.5%, 94.3%, and 85.4%, respectively (P < 0.001). In multivariate analysis, older age, advanced stage, and yolk sac tumor histology predicted for poorer survival.


CONCLUSIONS
Our data suggests that the use of fertility-preserving surgery with concomitant surgical staging for germ cell cancers has increased without compromising survival.
Chan
John K
JK
Department of Obstetrics, Gynecology, and Reproductive Sciences, University of California, San Francisco School of Medicine, UCSF Helen Diller Family, Comprehensive Cancer Center, San Francisco, California 94143-1702, USA. chanjohn@obgyn.ucsf.edu
Tewari
Krishnansu S
KS
Waller
Sarah
S
Cheung
Michael K
MK
Shin
Jacob Y
JY
Osann
Kathryn
K
Kapp
Daniel S
DS
D000293:Adolescent; D000328:Adult; D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D002648:Child; D002675:Child, Preschool; D005260:Female; D006801:Humans; D007223:Infant; D007247:Infertility, Female / Q000517:prevention & control*; D008875:Middle Aged; D015999:Multivariate Analysis; D009373:Neoplasms, Germ Cell and Embryonal / Q000401:mortality* / Q000473:pathology / Q000601:surgery*; D010051:Ovarian Neoplasms / Q000401:mortality* / Q000473:pathology / Q000601:surgery*; D018426:SEER Program; D016019:Survival Analysis