Thibault de la Motte Rouge1, Patricia Pautier2, Catherine Genestie3, Annie Rey4, Sébastien Gouy5, Alexandra Leary2, Christine Haie-Meder6, Pierre Kerbrat1, Stéphane Culine7, Karim Fizazi2, Catherine Lhommé8. 1. Department of Medical Oncology, Centre Eugène Marquis, Av de la bataille Flandres-Dunkerque, CS 44229, F-35042 Rennes, France. 2. Department of Cancer Medicine, Institut Gustave-Roussy, 114 rue Edouard Vaillant, F-94805 Villejuif, France. 3. Department of Biopathology, Institut Gustave-Roussy, 114 rue Edouard Vaillant, F-94805 Villejuif, France. 4. Department of Biostatistics, Institut Gustave-Roussy, 114 rue Edouard Vaillant, F-94805 Villejuif, France. 5. Department of Surgery, Institut Gustave-Roussy, 114 rue Edouard Vaillant, F-94805 Villejuif, France. 6. Department of Radiotherapy, Institut Gustave-Roussy, 114 rue Edouard Vaillant, F-94805 Villejuif, France. 7. Department of Medical Oncology, CHU Hôpital Saint Louis, 1 avenue Claude-Vellefaux, F-75010 Paris, France. 8. Department of Cancer Medicine, Institut Gustave-Roussy, 114 rue Edouard Vaillant, F-94805 Villejuif, France. Electronic address: catherine.lhomme@gustaveroussy.fr.
Abstract
BACKGROUND: The ovarian yolk sac tumor (OYST) is a very rare malignancy arising in young women. Our objective was to determine whether an early decline in serum alpha-fetoprotein (AFP) during chemotherapy has a prognostic impact. METHODS: This retrospective study is based on prospectively recorded OYST cases at Gustave Roussy (Cancer Treatment Center). Survival curves were estimated using the Kaplan-Meier method. The serum AFP decline was calculated with the formula previously developed and validated in male patients with poor prognosis non-seminomatous germ cell tumors. Univariate and multivariate analyses were performed using the log-rank test and logistic regression, respectively. RESULTS: Data on AFP were available to calculate an early AFP decline in 57 patients. All patients had undergone surgery followed by chemotherapy. The 5-year overall survival (OS) and event-free survival (EFS) rates were 86% (95% CI: 74%-93%) and 84% (95% CI: 73%-91%), respectively. The disease stage, presence of ascites at presentation, use of the BEP regimen, serum AFP half-life and an early AFP decline were significantly predictive factors for OS and EFS in the univariate analysis. The OS rate was 100% and 49% (95% CI: 26%-72%) in patients with a favorable AFP decline and in those with an unfavorable decline, respectively (p<0.001). In the multivariate analysis, only the presence of ascites at diagnosis (RR=7.3, p=0.03) and an unfavorable early AFP decline (RR=16.9, p<0.01) were significant negative predictive factors for OS. CONCLUSIONS: An early AFP decline during chemotherapy is an independent prognostic factor in patients with OYSTs. CONFLICT OF INTEREST STATEMENT: No conflict of interest.
BACKGROUND: The ovarian yolk sac tumor (OYST) is a very rare malignancy arising in young women. Our objective was to determine whether an early decline in serum alpha-fetoprotein (AFP) during chemotherapy has a prognostic impact. METHODS: This retrospective study is based on prospectively recorded OYST cases at Gustave Roussy (Cancer Treatment Center). Survival curves were estimated using the Kaplan-Meier method. The serum AFP decline was calculated with the formula previously developed and validated in male patients with poor prognosis non-seminomatous germ cell tumors. Univariate and multivariate analyses were performed using the log-rank test and logistic regression, respectively. RESULTS: Data on AFP were available to calculate an early AFP decline in 57 patients. All patients had undergone surgery followed by chemotherapy. The 5-year overall survival (OS) and event-free survival (EFS) rates were 86% (95% CI: 74%-93%) and 84% (95% CI: 73%-91%), respectively. The disease stage, presence of ascites at presentation, use of the BEP regimen, serum AFP half-life and an early AFP decline were significantly predictive factors for OS and EFS in the univariate analysis. The OS rate was 100% and 49% (95% CI: 26%-72%) in patients with a favorable AFP decline and in those with an unfavorable decline, respectively (p<0.001). In the multivariate analysis, only the presence of ascites at diagnosis (RR=7.3, p=0.03) and an unfavorable early AFP decline (RR=16.9, p<0.01) were significant negative predictive factors for OS. CONCLUSIONS: An early AFP decline during chemotherapy is an independent prognostic factor in patients with OYSTs. CONFLICT OF INTEREST STATEMENT: No conflict of interest.
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