title: Malignant ovarian germ cell tumors: presentation, survival and second cancer in a population based Norwegian cohort (1953-2009).
abstract: OBJECTIVE
  To quantify and compare survival in women with malignant ovarian germ cell tumors (MOGCTs) in Norway before and after the introduction of cisplatin-based chemotherapy (around 1980), and to explore the association between different types of treatment and the development of a second cancer.
  
  
  METHODS
  We identified 351 patients diagnosed with MOGCTs from 1953 to 2009 in the Cancer Registry of Norway. Ovarian cancer-specific survival was calculated separately for patients diagnosed before and after 1980. Patients were divided into subgroups by histological subtype (pure dysgerminoma, malignant teratoma, other MOGCTs) and extent of disease (localized and metastatic). We estimated the cumulative incidence of a second cancer in 10-year MOGCT survivors. Kaplan-Meier estimates were used, and p<0.05 was considered significant.
  
  
  RESULTS
  20-Year ovarian cancer-specific survival increased from 59% (95% CI 51% to 66%) before 1980 to 88% (95% CI 83%-93%) thereafter. Significant improvement was observed in all subgroups. No second cancer was diagnosed in any of 31 10-year MOGCT survivors treated with surgery only; second cancer was diagnosed in 23 of 139 patients who underwent cytotoxic treatment (98 radiotherapy ± chemotherapy, 41 chemotherapy only; p=0.08). Patients aged >50 years had a significantly poorer ovarian cancer-specific survival than younger patients (HR=5.98, 95% CI 3.39-10.57) after adjustment for histological subtype and stage at presentation. Our results favor the treatment of patients with metastatic MOGCTs at large cancer centers.
  
  
  CONCLUSIONS
  Today women with MOGCTs have an excellent prognosis if treated according to modern therapeutic principles.
authors.affiliation: Department of Gynaecologic Oncology, Oslo University Hospital, The Norwegian Radium Hospital, Oslo, Norway; National Resource Centre for Late Effects after Cancer Treatment, Oslo University Hospital, The Norwegian Radium Hospital, Oslo, Norway. Electronic address: OLSOLH@ous-hf.no.
authors.forename: O
authors.initials: O
authors.lastname: Solheim
authors.forename: J
authors.initials: J
authors.lastname: Kærn
authors.forename: C G
authors.initials: CG
authors.lastname: Tropé
authors.forename: E
authors.initials: E
authors.lastname: Rokkones
authors.forename: A A
authors.initials: AA
authors.lastname: Dahl
authors.forename: J M
authors.initials: JM
authors.lastname: Nesland
authors.forename: S D
authors.initials: SD
authors.lastname: Fosså
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use; D002648:Child; D002675:Child, Preschool; D002945:Cisplatin / Q000008:administration & dosage; D015331:Cohort Studies; D005260:Female; D006801:Humans; D015994:Incidence; D008875:Middle Aged; D009026:Mortality / Q000639:trends; D009373:Neoplasms, Germ Cell and Embryonal / Q000401:mortality* / Q000473:pathology / Q000628:therapy*; D016609:Neoplasms, Second Primary / Q000453:epidemiology* / Q000473:pathology / Q000628:therapy*; D009664:Norway / Q000453:epidemiology; D010051:Ovarian Neoplasms / Q000401:mortality* / Q000473:pathology / Q000628:therapy*; D011379:Prognosis; D012042:Registries; D055815:Young Adult
chemical_list: D002945:Cisplatin
keywords: Cisplatin-based chemotherapy; Malignant ovarian germ cell tumors; Second cancer; Survival