The role of staging and adjuvant chemotherapy in stage I malignant ovarian germ cell tumors (MOGTs)

the MITO-9 study

G Mangili, C Sigismondi, D Lorusso, G Cormio, M Candiani, G Scarfone, F Mascilini, A Gadducci, A M Mosconi, P Scollo, C Cassani, S Pignata, G Ferrandina

Research output: Contribution to journalArticle

9 Citations (Scopus)

Abstract

Background: Surgery followed by platinum-based chemotherapy is the standard of care for MOGCTs, except for stage IA dysgerminoma and stage IA grade 1 immature teratoma where surveillance only is recommended. The role of adjuvant chemotherapy and surgical staging is debated.

Patients and methods: Data from 144 patients with stage I MOGTs were collected among MITO centers (Multicenter Italian Trials in Ovarian Cancer) and analyzed.

Results: Fifty-five (38.2%) patients were affected by dysgerminomas, 49 (34%) by immature teratomas, 26 (18.1%) by yolk sac tumors and 14 (9.7%) by mixed tumors. Seventy-three (50.7%) patients receive surgery plus chemotherapy, while 71 (49.3%) patients underwent surgery alone. The latter group included 32 dysgerminomas (14 IA-13 Ix, 3 IB, and 2 IC), 34 immature teratomas (20 1A-13 IA grade 1, 6 Ix, 1 IB, and 7 IC), 4 mixed tumors and 1 yolk sac tumor. Forty-four patients did not received chemotherapy, even if it would have been indicated by recommended approach. 94 (65.3%) patients received peritoneal surgical staging. Twenty-three (15.9%) developed a recurrence. Incomplete surgical staging was associated with recurrence (P < 0.05; OR 2.37) at Cox regression analysis. Seven patients died. Four patients were affected by yolk sac tumors, two by mixed tumors and one by immature teratoma. Five patients died for disease, one for acute leukemia and one for suicide. Prognostic parameter analyses showed that yolk sac component is a predictor for survival (P < 0.05). Five-years OS rates were 96.8% and 88.7% in the surgically staged and the incomplete staged group, respectively, while 93.8% and 94.1% in the standard treatment and in the surveillance group, respectively.

Conclusions: This study shows that surveillance seems not to affect survival; chemotherapy should be reserved for relapse resulting in high cure rate. Incomplete peritoneal surgical staging is associated with recurrence. Yolk sac histology worsens the prognosis.

Original languageEnglish
Pages (from-to)333-338
Number of pages6
JournalAnnals of oncology : official journal of the European Society for Medical Oncology
Volume28
Issue number2
DOIs
Publication statusPublished - Feb 1 2017

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Germ Cell and Embryonal Neoplasms
Adjuvant Chemotherapy
Teratoma
Dysgerminoma
Endodermal Sinus Tumor
Recurrence
Drug Therapy
Yolk Sac
Neoplasms
Survival
Acute Disease
Standard of Care
Platinum
Ovarian Neoplasms
Suicide
Multicenter Studies
Histology
Leukemia
Regression Analysis

Keywords

  • Adolescent
  • Adult
  • Aged
  • Chemotherapy, Adjuvant
  • Child
  • Combined Modality Therapy
  • Female
  • Humans
  • Kaplan-Meier Estimate
  • Middle Aged
  • Multivariate Analysis
  • Neoplasm Staging
  • Neoplasms, Germ Cell and Embryonal
  • Ovarian Neoplasms
  • Retrospective Studies
  • Young Adult
  • Journal Article
  • Multicenter Study

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The role of staging and adjuvant chemotherapy in stage I malignant ovarian germ cell tumors (MOGTs) : the MITO-9 study. / Mangili, G; Sigismondi, C; Lorusso, D; Cormio, G; Candiani, M; Scarfone, G; Mascilini, F; Gadducci, A; Mosconi, A M; Scollo, P; Cassani, C; Pignata, S; Ferrandina, G.

In: Annals of oncology : official journal of the European Society for Medical Oncology, Vol. 28, No. 2, 01.02.2017, p. 333-338.

Research output: Contribution to journalArticle

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T1 - The role of staging and adjuvant chemotherapy in stage I malignant ovarian germ cell tumors (MOGTs)

T2 - the MITO-9 study

AU - Mangili, G

AU - Sigismondi, C

AU - Lorusso, D

AU - Cormio, G

AU - Candiani, M

AU - Scarfone, G

AU - Mascilini, F

AU - Gadducci, A

AU - Mosconi, A M

AU - Scollo, P

AU - Cassani, C

AU - Pignata, S

AU - Ferrandina, G

PY - 2017/2/1

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N2 - Background: Surgery followed by platinum-based chemotherapy is the standard of care for MOGCTs, except for stage IA dysgerminoma and stage IA grade 1 immature teratoma where surveillance only is recommended. The role of adjuvant chemotherapy and surgical staging is debated.Patients and methods: Data from 144 patients with stage I MOGTs were collected among MITO centers (Multicenter Italian Trials in Ovarian Cancer) and analyzed.Results: Fifty-five (38.2%) patients were affected by dysgerminomas, 49 (34%) by immature teratomas, 26 (18.1%) by yolk sac tumors and 14 (9.7%) by mixed tumors. Seventy-three (50.7%) patients receive surgery plus chemotherapy, while 71 (49.3%) patients underwent surgery alone. The latter group included 32 dysgerminomas (14 IA-13 Ix, 3 IB, and 2 IC), 34 immature teratomas (20 1A-13 IA grade 1, 6 Ix, 1 IB, and 7 IC), 4 mixed tumors and 1 yolk sac tumor. Forty-four patients did not received chemotherapy, even if it would have been indicated by recommended approach. 94 (65.3%) patients received peritoneal surgical staging. Twenty-three (15.9%) developed a recurrence. Incomplete surgical staging was associated with recurrence (P < 0.05; OR 2.37) at Cox regression analysis. Seven patients died. Four patients were affected by yolk sac tumors, two by mixed tumors and one by immature teratoma. Five patients died for disease, one for acute leukemia and one for suicide. Prognostic parameter analyses showed that yolk sac component is a predictor for survival (P < 0.05). Five-years OS rates were 96.8% and 88.7% in the surgically staged and the incomplete staged group, respectively, while 93.8% and 94.1% in the standard treatment and in the surveillance group, respectively.Conclusions: This study shows that surveillance seems not to affect survival; chemotherapy should be reserved for relapse resulting in high cure rate. Incomplete peritoneal surgical staging is associated with recurrence. Yolk sac histology worsens the prognosis.

AB - Background: Surgery followed by platinum-based chemotherapy is the standard of care for MOGCTs, except for stage IA dysgerminoma and stage IA grade 1 immature teratoma where surveillance only is recommended. The role of adjuvant chemotherapy and surgical staging is debated.Patients and methods: Data from 144 patients with stage I MOGTs were collected among MITO centers (Multicenter Italian Trials in Ovarian Cancer) and analyzed.Results: Fifty-five (38.2%) patients were affected by dysgerminomas, 49 (34%) by immature teratomas, 26 (18.1%) by yolk sac tumors and 14 (9.7%) by mixed tumors. Seventy-three (50.7%) patients receive surgery plus chemotherapy, while 71 (49.3%) patients underwent surgery alone. The latter group included 32 dysgerminomas (14 IA-13 Ix, 3 IB, and 2 IC), 34 immature teratomas (20 1A-13 IA grade 1, 6 Ix, 1 IB, and 7 IC), 4 mixed tumors and 1 yolk sac tumor. Forty-four patients did not received chemotherapy, even if it would have been indicated by recommended approach. 94 (65.3%) patients received peritoneal surgical staging. Twenty-three (15.9%) developed a recurrence. Incomplete surgical staging was associated with recurrence (P < 0.05; OR 2.37) at Cox regression analysis. Seven patients died. Four patients were affected by yolk sac tumors, two by mixed tumors and one by immature teratoma. Five patients died for disease, one for acute leukemia and one for suicide. Prognostic parameter analyses showed that yolk sac component is a predictor for survival (P < 0.05). Five-years OS rates were 96.8% and 88.7% in the surgically staged and the incomplete staged group, respectively, while 93.8% and 94.1% in the standard treatment and in the surveillance group, respectively.Conclusions: This study shows that surveillance seems not to affect survival; chemotherapy should be reserved for relapse resulting in high cure rate. Incomplete peritoneal surgical staging is associated with recurrence. Yolk sac histology worsens the prognosis.

KW - Adolescent

KW - Adult

KW - Aged

KW - Chemotherapy, Adjuvant

KW - Child

KW - Combined Modality Therapy

KW - Female

KW - Humans

KW - Kaplan-Meier Estimate

KW - Middle Aged

KW - Multivariate Analysis

KW - Neoplasm Staging

KW - Neoplasms, Germ Cell and Embryonal

KW - Ovarian Neoplasms

KW - Retrospective Studies

KW - Young Adult

KW - Journal Article

KW - Multicenter Study

U2 - 10.1093/annonc/mdw563

DO - 10.1093/annonc/mdw563

M3 - Article

VL - 28

SP - 333

EP - 338

JO - Annals of Oncology

JF - Annals of Oncology

SN - 0923-7534

IS - 2

ER -