32MO Long-term follow-up shows improved outcomes for stage IC-IV MOGCTs in a multicentre international analysis

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Background: malignant ovarian germ cell tumors (MOGCTs) are rare, aggressive malignancies predominantly affecting young women. The literature mainly consists of small studies suggesting advanced stage as an adverse prognostic factor. Few long-term follow-up data are available, showing 65% overall survival in stage IV disease. Here, we examine a large international series to define long-term prognosis. Methods: we analysed data from 254 FIGO stage IC/M-IV MOGCT patients, requiring surgery and chemotherapy between 1971 and 2018 at Charing Cross Hospital and Mount Vernon Cancer Center (UK) and the Multicentre Italian Trials in Ovarian Cancer (MITO) centres. Results: most patients (87.8%, n=223) received surgery as initial treatment (50.4%, n=128 fertility-sparing, 37.4%, n=95 non-sparing). Chemotherapy mainly consisted of BEP (48%, n=122) and POMB/ACE (42.5%, n=108). First-line treatment resulted in a complete response in 84.6% (n=215), partial response or stable disease in 7.9% (n=20), while 4.7% (n=12) progressed. Overall, 37 patients (14.6%) died of disease, with the last death recorded 8 years after initial diagnosis. 5-, 10-, and 20-year estimated cancer-specific survival (CSS) rates were 85.9% (95%CI, 80.6-89.8), 83.2% (95%CI, 77.3-87.7), and 83.2% (95%CI, 77.3-87.7), respectively. According to FIGO-stage, 10-year estimated CSS rates were 92.3% (95%CI, 82.1-96.8) for stage IC/M, 79.5% (95%CI, 56.2-91.3) for stage II, 79.4%, (95%CI, 69.5-86.4) for stage III and 79.4% (95%CI, 61.5-89.7) for stage IV. The 10-year estimated CSS for dysgerminoma and Grade 2/3 immature teratoma was 94.7% (95%CI, 84.4-98.3) and 97.5% (95%CI, 83.4-99.6), respectively. For other histologies, CSS was significantly lower: 77.8% (95%CI, 61.4-87.9) for mixed MOGCTs; 71.7% (95%CI, 58.4-81.4) for yolk sac tumors (YST); 50.0% (95%CI, 5.9-84.5) for choriocarcinoma; and 33.3% (95%CI, 1.0-77.4) for embryonal carcinoma, p<0.001. Conclusions: our analysis shows (1) improved outcomes of patients with stage IC-IV MOGCTs, compared to previously published data with 80% long-term survival in stage IV disease and (2) a need for long term follow up, as late relapses can occur.

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