| Article ID | Journal | Published Year | Pages | File Type |
|---|---|---|---|---|
| 3942651 | Gynecologic Oncology | 2015 | 7 Pages |
•This manuscript details the largest investigation of patients with malignant gynecologic germ cell tumors ever reported•We developed a risk stratification system that was highly prognostic for progression-free and overall survival•This system may help to establish treatment algorithms that minimize toxicity and maximize efficacy in this population
ObjectiveDue to their rarity, little is known about prognostic factors in female germ cell tumors (GCTs) or outcomes following systemic therapy. Management is largely based on studies of male GCT and epithelial ovarian cancer.MethodsChart review was performed for all females with GCT seen at Memorial Sloan Kettering Cancer Center (MSKCC) from 1990 to 2012. Patients receiving chemotherapy were stratified using a modification of the male IGCCCG risk system, and the classifier was correlated with outcome.ResultsOf 93 patients, 92 (99%) underwent primary surgery and 85 (92%) received chemotherapy. Modified IGCCCG classification was significantly associated with progression-free survival (PFS) and overall survival (OS), both when applied preoperatively and pre-chemotherapy (p < 0.001 for all four analyses). Progression after initial chemotherapy (n = 29) was detected by imaging in 14 (48%) patients, by serum tumor markers in 6 (21%) patients, and by multiple methods in the rest. Seven (29%) of 24 patients treated with salvage chemotherapy achieved long-term PFS, including 4/6 who received high-dose chemotherapy (HDCT) as initial salvage versus 3/16 treated with other initial salvage regimens. The estimated 3-year OS rate was 84% (95% CI, 76–92%), with a trend favoring dysgerminoma over non-dysgerminoma histologies (p = 0.12).ConclusionsModified IGCCCG classification was prognostic for female GCT patients in this cohort and identified a poor-risk group who may benefit from more intensive first-line chemotherapy. Both imaging and tumor marker evaluation were important in identifying relapses after first-line chemotherapy. The majority of long-term remissions with salvage therapy were achieved with initial salvage HDCT.
