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Surgical resection and outcome of malignant ovarian germ cell tumors in children—a national multicentric study compared to international results

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Abstract

Purpose

To evaluate the outcome of pediatric malignant ovarian germ cell tumors treated by three tertiary Egyptian institutions, and to compare our national experience to internationally published data.

Methods

This is a retrospective analysis of all patients presenting between September 2014 and September 2019. Management protocol was Children's Oncology Group (COG) in all participating centers. Overall survival (OS), event-free survival (EFS) and univariate prognostic factors were estimated by Kaplan–Meier and log-rank test. Additionally, a review of various practices that reported survival outcome was conducted.

Main results

Thirty-seven patients were included with a median age of 10.5 years (1–18 years). Thirty-five patients had unilateral salpingo-oophorectomy. Mixed germ cell and yolk sac tumors represented 75.7% of patients. There were 7 (19%), 14 (37.8%), 12 (32.4%) and 4 (10.8%) stage I, II, III and IV, respectively. Seven patients were low risk (LR), 26 intermediate risk (IR) and 4 high risk (HR). Platinum-based chemotherapy was administered as per risk stratification. Follow-up to March 2020 revealed that five patients had relapsed. There were no statistical significances of pathological types and patients' age regarding OS (p value 0.392 and 0.281, respectively) and EFS (p value 0.420 and 0.437, respectively). Three-year OS was 84%: 100% for stages I and II, and 62% for stages III and IV (p = 0.003); 100% for LR, 89% for IR, and 24% for HR (p < 0.001). Three-year EFS was 87%: 96% for stages I and II, and 71% for stages III and IV (p = 0.025); 100% for LR, 92% for IR, and 26% for HR (p < 0.001).

Conclusion

Surgical resection combined with chemotherapy achieves excellent outcome for such tumors in both, present study and previous reports. On the basis of our results, COG staging and risk stratification were significantly correlated with prognosis, whereas tumor pathology and age had no significant impact. Prognostic factors are controversial among studies, and further research is still required.

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Funding

This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors.

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Authors and Affiliations

  1. Surgical Oncology Unit, Faculty of Medicine, Tanta University, Tanta, Egypt

    Ahmed Elgendy

  2. Pediatric Surgery Department, Assiut University, Assiut, Egypt

    Mahmoud Mostafa

  3. Surgical Oncology Department, South Egypt Cancer Institute, Assiut University, Assiut, Egypt

    Mohamed Abouelmagd Salem

  4. Pediatric Oncology Department, South Egypt Cancer Institute, Assiut University, Assiut, Egypt

    Amany Ali

  5. Pediatric Surgery Department, Alexandria University, Alexandria, Egypt

    Ahmed Khairi & Sameh Shehata

Authors
  1. Ahmed Elgendy
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  2. Mahmoud Mostafa
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  3. Mohamed Abouelmagd Salem
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  4. Amany Ali
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  5. Ahmed Khairi
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  6. Sameh Shehata
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Contributions

Study design: AE; patients’ management: all authors; data collection: all authors; data analysis: AE; manuscript writing: AE; manuscript critical review: AE, MM, and SS. All authors read and approved the final copy of the manuscript.

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Correspondence to Ahmed Elgendy.

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All the authors declare that they have no conflict of interest.

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All procedures performed in this study involving human participants were in accordance with the ethical standards of the institutional committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

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Elgendy, A., Mostafa, M., Salem, M.A. et al. Surgical resection and outcome of malignant ovarian germ cell tumors in children—a national multicentric study compared to international results. Pediatr Surg Int 36, 1067–1075 (2020). https://doi.org/10.1007/s00383-020-04716-x

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  • DOI: https://doi.org/10.1007/s00383-020-04716-x

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