Prognostic factors for pure ovarian immature teratoma and the role of adjuvant chemotherapy in stage I diseases

Figures & data

Table 1. Clinical characteristics of POIT patients in the overall cohort (N = 155).

Characteristics	Number (percentile)
Age (y)	22.2/23.0 (4-39)
Median follow-up time (y, range)	7.6 (0.3-21.8)
Mass size (cm)	15.3/15.0 (3.0 − 32.0)
Ascites volume (ml, N = 47)	1372/400 (50 – 10000)
Elevated TM (N = 145)	120 (82.8%)
Elevated AFP (N = 145)	89 (61.4%)
Preoperative AFP (ng/ml, N = 127)	104.6 (8.6 − 495.4)
Preoperative CA125 (U/ml, N = 107)	98.0 (41.2 − 308.6)
Preoperative CA19-9 (U/ml, N = 64)	55.8 (19.2 − 164.4)
Negative postoperative TM (N = 145)	63 (43.4%)
Postoperative AFP (ng/ml, N = 137)	11.8 (2.2 − 69.3)
Postoperative CA125 (U/ml)	34.1 (15.9 − 76.5)
Postoperative CA19-9 (U/ml)	17.2 (8.6 − 42.6)
GP at first treatment	15 (9.7%)
FIGO stage
IA	55 (35.5%)
IC	71 (45.8%)
II	2 (1.3%)
IIIA	2 (1.3%)
IIIB	8 (5.2%)
IIIC	16 (10.3%)
IV	1 (0.6%)
Tumor grade
G1	40 (25.8%)
G2	62 (40.0%)
G3	47 (30.3%)
Unknow (GX)	6 (3.9%)

Abbreviations: POIT: pure ovarian immature teratoma; TM: tumor markers; AFP: α- fetoprotein; GP: gliomatosis peritonei.

Notes: Age, mass size, and ascites volume were listed as mean/median (range); preoperative/postoperative AFP, CA125, and CA19-9 levels were listed as median (IQR). FIGO stage was classified as the FIGO 2014 version.

Table 2. Management and survival outcomes in POIT patients of overall cohort (N = 155).

Characteristics	Number (percentile)
Surgery at diagnosis
Fertility-sparing surgery	146 (94.2%)
Radical surgery	9 (5.8%)
Complete surgical staging	81 (52.3%)
FSS staging	72 (88.9%)
Non-FSS staging	9 (11.1%)
Chemotherapy	117 (75.5%)
BEP/BVP regimens	115 (98.3%)
Recurrence after first treatment
Not CR	1 (0.7%)
No	131 (84.5%)
Immature teratoma	23 (14.8%)
GP at R1	10/23 (43.5%)
GTS after first treatment	27 (17.4%)
Surgery at R1
No	1 (4.3%)
FSS RCRS	17 (73.9%)
Non-FSS RCRS	5 (21.7%)
R0 resection at R1 (N = 22)	19 (86.4%)
Chemotherapy at R1	21 (91.3%)
Outcomes after R1
No evidence of diseases	19 (82.6%)
Alive with the disease	4 (17.4%)
Second Recurrence	7/19 (36.8%)
Diseases outcomes
No evidence of disease	148 (95.5%)
Alive with the disease	2 (1.3%)
Died of the disease	5 (3.2%)

Abbreviations: POIT: pure ovarian immature teratoma; FSS: fertility-sparing surgery; CR: complete remission; BEP/BVP: bleomycin, etoposide, and cisplatin/bleomycin, vincristine, and cisplatin; GTS: growing teratoma syndrome; GP: gliomatosis peritonei; R1: first recurrence; RCRS: repeat cytoreductive surgery.

Figure 1. (A) The Kaplan-Meier (log-rank test) curves showed the RFS and DSS rates in this overall POIT cohort. (B) POIT patients with positive postoperative TM had a significantly higher risk of recurrence compared with those who had negative postoperative TM. (C) FIGO stage II-IV significantly increased the mortality risk in POIT patients compared with stage I. (D) The 5-year RFS and DSS rates in stage I POIT except IA G1 subgroup were 88.8% and 99.0%, respectively. (E) A significant difference in RFS rate was noted based on the postoperative TM level (negative vs. positive) in stage I POIT patients except IA G1. (F) Patients who received adjuvant chemotherapy showed significantly better RFS compared with those with active surveillance in POIT of stage IA G2-G3 and IB-IC of any grade.

Table 3. Clinical characteristics of patients with stage I POIT except IA G1 subgroup (N = 110).

	Active Surveillance (N = 29)	Adjuvant Chemotherapy (N = 81)	Overall cohort (N = 110)
Age (y)	26.0 (5 - 39)	21.0 (4 - 39)	23.0 (4 – 39)
Follow-up time (y)	7.4 (0.3 − 17.7)	7.7 (0.4 − 21.8)	7.7 (0.3 − 21.8)
Elevated TMs	20/29 (69.0%)	68/81 (84.0%)	88/110 (80.0%)
Elevated AFP	13/29 (44.8%)	50/81 (61.7%)	63/110 (57.3%)
Negative postoperative TMs	20/29 (69.0%)	34/81 (42.0%)	54/110 (49.1%)
FIGO stage
IA	9 (31.0%)	33 (40.7%)	42 (38.2%)
G2	6	22	28
G3	3	11	14
IC	20 (69.0%)	48 (59.3%)	68 (61.8%)
G1	12	11	23
G2	6	23	29
G3	2	14	16
Fertility-sparing surgery	28 (96.6%)	77 (95.1%)	105 (95.5%)
Cystectomy (no staging)	14	23	37
USO (no staging)	8	19	27
Complete Surgical staging	7 (24.1%)	39 (48.1%)	46 (41.8%)
FSS staging	6 (20.7%)	35 (43.2%)	41 (37.3%)
Cystectomy with staging	2	9	11
USO with staging	4	26	30
Non-FSS staging	1 (3.4%)	4 (4.9%)	5 (4.5%)
First Recurrence (R1)
No	17 (58.6%)	68 (84.0%)	85 (77.3%)
Mature teratoma	5 (17.2%)	7 (8.6%)	12 (10.9%)
Immature teratoma	7 (24.1%)	6 (7.4%)	13 (11.8%)
Treatment at R1
Surgery	1	0	1 (7.7%)
Surgery + chemotherapy	6	5	11 (84.6%)
Chemotherapy + EBRT	0	1	1 (7.7%)
Diseases outcomes
No evidence of diseases	28 (96.6%)	80 (98.8%)	108 (98.2%)
Died of the diseases	1 (3.4%)	1 (1.2%)	2 (1.8%)

Abbreviations: POIT: pure ovarian immature teratoma; TM: tumor markers; FSS: fertility-sparing surgery; AFP: α-fetoprotein; USO: unilateral salpingo-oophorectomy; EBRT: external beam radiotherapy.

Note: the age and follow-up time were listed as median (range).

Figure 2. (A–C) Tumor grades (a), surgical options (B), and incomplete surgical staging (C) did not significantly affect the RFS in stage I POIT excluded IA G1. (D) Adjuvant chemotherapy did not significantly improve the DSS rate compared with active surveillance in stage I POIT except IA G1.

Data availability statement

All data generated or analyzed during this study are included in this published article and the supplementary information files. The datasets used and/or analyzed during the current study can be obtained from the corresponding author upon reasonable request.