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Joyce F. Liu, MD, MPH
Joyce F. Liu, MD, MPH
Posted: Friday, July 24, 2026
Advanced stage, age 35 years or older, and nondysgerminoma histology were independently associated with worse cancer-specific survival in patients with malignant ovarian germ cell tumors, according to a large, multicenter, international study published in the Journal of Clinical Oncology. The study was led by Alice Bergamini, MD, PhD, of the Department of Obstetrics and Gynecology, San Raffaele Hospital, and Università Vita-Salute San Raffaele, Milan, Italy.
The investigators analyzed data from 254 patients with International Federation of Gynecology and Obstetrics stage IC through IV malignant ovarian germ cell tumors. All patients were undergoing surgery and chemotherapy between 1971 and 2018 at two centers in the United Kingdom and through the Multicenter Italian Trials in Ovarian Cancer network.
Patients had a median age at diagnosis of 27 years, and the median follow-up from the end of last treatment was 6.9 years. Initial treatment was surgery in 87.8% of patients, with 50.4% undergoing fertility-sparing procedures; the other most common initial treatment was neoadjuvant chemotherapy. About one-third of patients (32.5%) received high-dose chemotherapy at relapse.
First-line treatment led to a complete response in 84.6% of patients. Thirty-seven patients (14.6%) died of disease. At 10 years, the cancer-specific survival rate was 83.2% and the progression-free survival rate was 82.8%. The 10-year cancer-specific survival rate for patients with stage IV disease was 79.4%.
On multivariable analysis, age 35 years or older (hazard ratio [HR] = 2.8; 95% confidence interval [CI] = 1.5–5.4; P = .003), stage III or IV disease (HR = 1.4; 95% CI = 0.2–1.9; P = .035), and nondysgerminoma histology (HR = 7.3; 95% CI = 1.9–64.8; P = .001), were associated with worse cancer-specific survival. Outcomes were better with grade 2/3 postpubertal immature teratomas, which was considered equivalent to dysgerminomas.
Among patients who relapsed, high-dose chemotherapy appeared to improve survival when used in first relapse, with a 5-year progression-free survival rate of 45%, but all patients who received it in subsequent relapses died of disease. Most relapses (78%) occurred within 2 years, though three late relapses were recorded at 6, 14, and 22 years, underscoring the need for long-term surveillance.
Disclosure: Supported by the Imperial Experimental Cancer Medicine Center. For full disclosures of the study authors, visit ascopubs.org.
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