abstract
OBJECTIVE:
Due
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.
METHODS:
Chart
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.
RESULTS:
Of
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).
CONCLUSIONS:
Modified
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.
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