BACKGROUND. Combination chemotherapy has dramatically improved the prognosi
s of patients with nondysgerminomatous ovarian germ cell tumors (NDOGCT). H
owever, guidelines are needed for the identification of patients at risk of
relapse.
METHODS. The authors performed a retrospective analysis of women with NDOGC
T managed during the period 1970-1994 at the Royal Marsden Hospital and oth
er hospitals of the London Gynaecological Oncology Group.
RESULTS, Sixty-nine women were included; their median follow-up was 5.7 yea
rs (minimum, 12 months). The median age was 21 years (range, 4-44 years), w
ith a histology of immature teratoma (IT) for 17 patients, endodermal sinus
tumor (EST) for 20 patients, and mixed tumors for 32 patients. Thirty-five
patients (51%) had Stage I disease. Nine patients with Stage I tumors were
observed without further therapy (six with IT and three with mixed tumors)
, and one relapsed. Seven patients received non-platinum-based chemotherapy
, and four relapsed. A total of 52 patients were treated with platinum-base
d chemotherapy, with relapse free and overall survival rates of 87% (95% co
nfidence interval [CI], 73-93%) and 84% (95% CI, 70-91%), respectively. Of
these patients, relapse was seen in 0 of 9 IT patients, 1 of 25 patients wi
th mixed tumors, and 6 of 18 EST patients. With alpha-fetoprotein (AFP) > 1
000 kU/L, relapse was seen in 6 of 18 patients compared with 1 of 33 relaps
es with lower AFP levels. In multivariate analysis, including all patients
who received chemotherapy, AFP >1000kU/L (P = 0.001) and non-platinum-based
chemotherapy (P = 0.005) were associated with relapse. When only patients
given platinum-based treatment were considered, EST histology (P = 0.003) a
nd AFP >1000 kU/L (P = 0.003) were associated with relapse in univariate an
alysis; however, these factors were linked. No malignant tumor was found at
second-look surgery performed on 24 patients. Of 26 women assessable for f
ertility, 24 subsequently recommenced regular menstrual function, and 11 pa
tients had pregnancies.
CONCLUSIONS. Platinum-based chemotherapy has been confirmed to be effective
in the management of patients with NDOGCT. Relapses were principally seen
among patients with AFP >1000 kU/L or pure EST histology. Efforts to improv
e outcome need to focus on patients with EST, whereas less intensive manage
ment strategies may be appropriate for some patients with IT. Cancer 1999;8
5:2232-44. (C) 1999 American Cancer Society.