title: Prognostic significance of an early decline in serum alpha-fetoprotein during chemotherapy for ovarian yolk sac tumors.
abstract: The ovarian yolk sac tumor (OYST) is a very rare malignancy arising in young women. Our objective was to determine whether an early decline in serum alpha-fetoprotein (AFP) during chemotherapy has a prognostic impact.
  
  
  
  This retrospective study is based on prospectively recorded OYST cases at Gustave Roussy (Cancer Treatment Center). Survival curves were estimated using the Kaplan-Meier method. The serum AFP decline was calculated with the formula previously developed and validated in male patients with poor prognosis non-seminomatous germ cell tumors. Univariate and multivariate analyses were performed using the log-rank test and logistic regression, respectively.
  
  
  
  Data on AFP were available to calculate an early AFP decline in 57 patients. All patients had undergone surgery followed by chemotherapy. The 5-year overall survival (OS) and event-free survival (EFS) rates were 86% (95% CI: 74%-93%) and 84% (95% CI: 73%-91%), respectively. The disease stage, presence of ascites at presentation, use of the BEP regimen, serum AFP half-life and an early AFP decline were significantly predictive factors for OS and EFS in the univariate analysis. The OS rate was 100% and 49% (95% CI: 26%-72%) in patients with a favorable AFP decline and in those with an unfavorable decline, respectively (p<0.001). In the multivariate analysis, only the presence of ascites at diagnosis (RR=7.3, p=0.03) and an unfavorable early AFP decline (RR=16.9, p<0.01) were significant negative predictive factors for OS.
  
  
  
  An early AFP decline during chemotherapy is an independent prognostic factor in patients with OYSTs.
  
  
  
  No conflict of interest.
authors.affiliation: Department of Medical Oncology, Centre Eugène Marquis, Av de la bataille Flandres-Dunkerque, CS 44229, F-35042 Rennes, France.
authors.forename: Thibault
authors.initials: T
authors.lastname: de la Motte Rouge
authors.affiliation: Department of Cancer Medicine, Institut Gustave-Roussy, 114 rue Edouard Vaillant, F-94805 Villejuif, France.
authors.forename: Patricia
authors.initials: P
authors.lastname: Pautier
authors.affiliation: Department of Biopathology, Institut Gustave-Roussy, 114 rue Edouard Vaillant, F-94805 Villejuif, France.
authors.forename: Catherine
authors.initials: C
authors.lastname: Genestie
authors.affiliation: Department of Biostatistics, Institut Gustave-Roussy, 114 rue Edouard Vaillant, F-94805 Villejuif, France.
authors.forename: Annie
authors.initials: A
authors.lastname: Rey
authors.affiliation: Department of Surgery, Institut Gustave-Roussy, 114 rue Edouard Vaillant, F-94805 Villejuif, France.
authors.forename: Sébastien
authors.initials: S
authors.lastname: Gouy
authors.affiliation: Department of Cancer Medicine, Institut Gustave-Roussy, 114 rue Edouard Vaillant, F-94805 Villejuif, France.
authors.forename: Alexandra
authors.initials: A
authors.lastname: Leary
authors.affiliation: Department of Radiotherapy, Institut Gustave-Roussy, 114 rue Edouard Vaillant, F-94805 Villejuif, France.
authors.forename: Christine
authors.initials: C
authors.lastname: Haie-Meder
authors.affiliation: Department of Medical Oncology, Centre Eugène Marquis, Av de la bataille Flandres-Dunkerque, CS 44229, F-35042 Rennes, France.
authors.forename: Pierre
authors.initials: P
authors.lastname: Kerbrat
authors.affiliation: Department of Medical Oncology, CHU Hôpital Saint Louis, 1 avenue Claude-Vellefaux, F-75010 Paris, France.
authors.forename: Stéphane
authors.initials: S
authors.lastname: Culine
authors.affiliation: Department of Cancer Medicine, Institut Gustave-Roussy, 114 rue Edouard Vaillant, F-94805 Villejuif, France.
authors.forename: Karim
authors.initials: K
authors.lastname: Fizazi
authors.affiliation: Department of Cancer Medicine, Institut Gustave-Roussy, 114 rue Edouard Vaillant, F-94805 Villejuif, France. Electronic address: catherine.lhomme@gustaveroussy.fr.
authors.forename: Catherine
authors.initials: C
authors.lastname: Lhommé
mesh_terms: D000293:Adolescent; D000328:Adult; D018240:Endodermal Sinus Tumor / Q000097:blood* / Q000188:drug therapy* / Q000473:pathology; D005260:Female; D006801:Humans; D008875:Middle Aged; D009367:Neoplasm Staging; D010051:Ovarian Neoplasms / Q000097:blood* / Q000188:drug therapy* / Q000473:pathology; D011379:Prognosis; D012189:Retrospective Studies; D055815:Young Adult; D000509:alpha-Fetoproteins / Q000378:metabolism*
chemical_list: C097353:AFP protein, human; D000509:alpha-Fetoproteins
keywords: Alpha-fetoprotein; BEP; Chemotherapy; Endodermal sinus tumor; Germ cell tumor; Malignant ovarian germ cell tumor