A Population-Based Analysis of 1037 Malignant Ovarian Tumors in the Pediatric Population

BackgroundConcerns of malignant potential have impacted the utilization of ovarian salvage for treatment of ovarian masses in children.MethodsThe Surveillance, Epidemiology, and End Results (SEER) registry was analyzed for all females ≤ 19 y diagnosed with an ovarian tumor between 1973 and 2005.ResultsOverall, 1037 pediatric patients with ovarian tumors were identified. Approximately 61.7% of tumors occurred in patients 15 to 19 y old. The age-adjusted incidence of all malignant pediatric ovarian tumors in those ≤ 9 y was 0.102 versus 1.072 per 100,000 in those aged 10 to 19 y. The majority of cases (57.4%) present at an early localized stage. The predominant pathology was germ cell tumors in all age groups (77.4%). Overall 5- and 10-y survival rates are 91.7% and 91.4%, respectively. By multivariate analysis, advanced disease stage (HR 3.17, P < 0.001), lack of surgery (HR 4.49, P = 0.039), and poorly differentiated tumors (HR 3.40, P = 0.011) were associated with worse outcomes.ConclusionsMalignant ovarian tumors are rare, particularly in patients under 5 y of age. Furthermore, the most common histologies are of low metastatic potential and carry high cure rates. Thus, the surgeon should implement ovarian-sparing strategies on the affected ovary unless a malignancy is clearly suspected and conserve the contralateral ovary in all children.