Toyomi Satoh1, Yoichi Aoki2, Takahiro Kasamatsu3, Kazunori Ochiai4, Masashi Takano5, Yoh Watanabe6, Fumitaka Kikkawa7, Nobuhiro Takeshima8, Masayuki Hatae9, Harushige Yokota10, Toshiaki Saito11, Nobuo Yaegashi12, Hiroaki Kobayashi13, Tsukasa Baba14, Shoji Kodama15, Tsuyoshi Saito16, Noriaki Sakuragi17, Toshiyuki Sumi18, Toshiharu Kamura19, Hiroyuki Yoshikawa20. 1. Department of Obstetrics and Gynecology, Faculty of Medicine, University of Tsukuba, Tsukuba, Japan. Electronic address: toyomi-s@md.tsukuba.ac.jp. 2. Department of Obstetrics and Gynecology, Graduate School of Medical Science, University of the Ryukyus, Naha, Japan. 3. Department of Gynecologic, National Cancer Center Hospital, Tokyo, Japan. 4. Department of Obstetrics and Gynecology, The Jikei University School of Medicine, Tokyo, Japan. 5. Department of Obstetrics and Gynecology, National Defense Medical College, Saitama, Japan. 6. Department of Obstetrics and Gynecology, Kinki University Faculty of Medicine, Osaka, Japan. 7. Department of Obstetrics and Gynecology, Nagoya University Graduate School of Medicine, Nagoya, Japan. 8. Department of Gynecology, Cancer Institute Hospital, Tokyo, Japan. 9. Department of Obstetrics and Gynecology, Kagoshima City Hospital, Kagoshima, Japan. 10. Department of Gynecology, Saitama Cancer Center, Ina, Japan. 11. Gynecology Service, National Kyushu Cancer Center, Fukuoka, Japan. 12. Department of Obstetrics and Gynecology, Tohoku University, Sendai, Japan. 13. Department of Obstetrics and Gynecology, Graduate School of Medical Sciences Kyushu University, Fukuoka, Japan. 14. Department of Gynecology and Obstetrics, Kyoto University Graduate School of Medicine, Kyoto, Japan. 15. Department of Gynecology, Niigata Cancer Center Hospital, Niigata, Japan. 16. Department of Obstetrics and Gynecology, Sapporo Medical University School of Medicine, Sapporo, Japan. 17. Department of Gynecology and Obstetrics, Hokkaido University, Sapporo, Japan. 18. Department of Obstetrics and Gynecology, Osaka City University Graduate School of Medicine, Osaka, Japan. 19. Department of Obstetrics and Gynecology, Kurume University School of Medicine, Kurume, Japan. 20. Department of Obstetrics and Gynecology, Faculty of Medicine, University of Tsukuba, Tsukuba, Japan.
Abstract
AIM: The aim of this study was to investigate prognostic factors, including postoperative chemotherapy regimen, for the treatment of ovarian yolk sac tumour (YST), and resulting fertility outcome. METHODS: A multi-institutional retrospective investigation was undertaken to identify patients with ovarian pure or mixed YST who were treated between 1980 and 2007. Postoperative chemotherapy regimen and other variables were assessed in univariate and multivariate analyses. Additionally, the reproductive safety of the BEP (bleomycin, etoposide and cisplatin) regimen was evaluated. RESULTS: There were 211 patients enrolled from 43 institutions. The BEP regimen and a non-BEP regimen were administered to 112 and 99 patients as postoperative chemotherapy, respectively. In univariate and multivariate analyses, age⩾22, alpha-fetoprotein⩾33,000 ng/ml, residual tumours after surgery and non-BEP regimen were independently and significantly associated with poor overall survival (OS). BEP was significantly superior to non-BEP in 5-year OS (93.6% versus 74.6%, P=0.0004). Reduced-dose BEP (<75% standard-dose bleomycin and<50% etoposide dose) was significantly associated with poorer 5-year OS compared with standard-dose BEP (89.4% versus 100%, P=0.02 and 62.5% versus 96.9%, P=0.0002). All patients who underwent fertility-sparing surgery recovered their menstrual cycles. Sixteen of 23 patients receiving BEP (70.0%) and 13 of 17 patients receiving non-BEP (76.5%) who were nulliparous at fertility-sparing surgery and married at the time of investigation gave birth to 21 and 19 healthy children, respectively. CONCLUSIONS: The results of the present study suggest that standard-dose BEP should be administered for ovarian YST. BEP is as safe as non-BEP for preserving reproductive function.
AIM: The aim of this study was to investigate prognostic factors, including postoperative chemotherapy regimen, for the treatment of ovarian yolk sac tumour (YST), and resulting fertility outcome. METHODS: A multi-institutional retrospective investigation was undertaken to identify patients with ovarian pure or mixed YST who were treated between 1980 and 2007. Postoperative chemotherapy regimen and other variables were assessed in univariate and multivariate analyses. Additionally, the reproductive safety of the BEP (bleomycin, etoposide and cisplatin) regimen was evaluated. RESULTS: There were 211 patients enrolled from 43 institutions. The BEP regimen and a non-BEP regimen were administered to 112 and 99 patients as postoperative chemotherapy, respectively. In univariate and multivariate analyses, age⩾22, alpha-fetoprotein⩾33,000 ng/ml, residual tumours after surgery and non-BEP regimen were independently and significantly associated with poor overall survival (OS). BEP was significantly superior to non-BEP in 5-year OS (93.6% versus 74.6%, P=0.0004). Reduced-dose BEP (<75% standard-dose bleomycin and<50% etoposide dose) was significantly associated with poorer 5-year OS compared with standard-dose BEP (89.4% versus 100%, P=0.02 and 62.5% versus 96.9%, P=0.0002). All patients who underwent fertility-sparing surgery recovered their menstrual cycles. Sixteen of 23 patients receiving BEP (70.0%) and 13 of 17 patients receiving non-BEP (76.5%) who were nulliparous at fertility-sparing surgery and married at the time of investigation gave birth to 21 and 19 healthy children, respectively. CONCLUSIONS: The results of the present study suggest that standard-dose BEP should be administered for ovarian YST. BEP is as safe as non-BEP for preserving reproductive function.
Authors: Silvia Schmidtova; Lambert C J Dorssers; Michal Mego; Lucia Kucerova; Leendert H J Looijenga; Katarina Kalavska; Ad J M Gillis; J Wolter Oosterhuis; Hans Stoop; Svetlana Miklikova; Zuzana Kozovska; Monika Burikova; Katarina Gercakova; Erika Durinikova; Michal Chovanec Journal: Cancer Cell Int Date: 2020-08-03 Impact factor: 5.722