title: Outcome and risk factors for recurrence in malignant ovarian germ cell tumors: a MITO-9 retrospective study.
abstract: OBJECTIVE
  This study aimed to investigate the outcome of patients with malignant ovarian germ cell tumors (MOGCTs) and to define the risk factors for recurrence.
  
  
  METHODS
  A total of 123 patients with MOGCTs were retrospectively reviewed among MITO centers. Eighty-one patients had primary treatment in a MITO center, whereas the other 42 were referred for adjuvant chemotherapy or recurrence. The clinicopathologic characteristics were evaluated for association with relapse or death.
  
  
  RESULTS
  Median age was 24 years (range, 11-76 years). Forty-nine (39.8%) had dysgerminomas, 35 (28.5%) had immature teratomas, 12 (9.8%) had mixed germ cell tumors, 26 (21.1%) had yolk sac tumors, and 1 (0.8%) had embryonal carcinoma. International Federation of Gynecology and Obstetrics stage distribution was as follows: stage I, 87 (70.7%); stage II, 3 (2.4%); stage III, 29 (23.6%); and stage IV, 4 (3.3%). Fertility-sparing surgery was performed in 92 patients, whereas the remaining 31 received radical surgery; 65.8% of patients received adjuvant chemotherapy. Recurrence rate was 17.8% and the median time to recurrence was 9 months. Univariate and multivariate analyses showed that patient age (>45 years) and treatment outside a referral (MITO) center were the most important predictors of recurrence. The 5-year overall survival rate was 88.8%, with a median follow-up of 61 months. Univariate and multivariate analyses demonstrated that stage greater than I and yolk sac tumors were independent poor prognostic indicators.
  
  
  CONCLUSIONS
  This study confirms that MOGCTs have excellent prognosis, with 5-year overall survival rates of 95.6% and 73.2% in stage I and advanced stages, respectively. Age older than 45 years and treatment not in a referral center are independent risk factors for recurrence, whereas stage greater than I and yolk sac histology are independent poor prognostic indicators.
authors.affiliation: Gynecology Department, IRCCS San Raffaele Hospital, Milan. mangili.giorgia@hsr.it
authors.forename: Giorgia
authors.initials: G
authors.lastname: Mangili
authors.forename: Cristina
authors.initials: C
authors.lastname: Sigismondi
authors.forename: Angiolo
authors.initials: A
authors.lastname: Gadducci
authors.forename: Gennaro
authors.initials: G
authors.lastname: Cormio
authors.forename: Paolo
authors.initials: P
authors.lastname: Scollo
authors.forename: Saverio
authors.initials: S
authors.lastname: Tateo
authors.forename: Gabriella
authors.initials: G
authors.lastname: Ferrandina
authors.forename: Stefano
authors.initials: S
authors.lastname: Greggi
authors.forename: Massimo
authors.initials: M
authors.lastname: Candiani
authors.forename: Domenica
authors.initials: D
authors.lastname: Lorusso
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D002648:Child; D005260:Female; D006801:Humans; D007558:Italy / Q000453:epidemiology; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000401:mortality*; D009373:Neoplasms, Germ Cell and Embryonal / Q000401:mortality* / Q000473:pathology; D010051:Ovarian Neoplasms / Q000401:mortality* / Q000473:pathology; D010053:Ovary / Q000473:pathology; D011379:Prognosis; D012189:Retrospective Studies; D012307:Risk Factors; D055815:Young Adult