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The individualized significance of lymphadenectomy across all age groups and histologies in malignant ovarian germ cell tumors

  • Gynecologic Oncology
  • Published:
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Abstract

Purpose

To evaluate the therapeutic role of lymphadenectomy on patients with malignant ovarian germ cell tumor (MOGCT) and to investigate the risk factors of lymph node metastasis.

Methods

Patients of MOGCT between 1988 and 2013 with definite lymph node information were extracted from the Surveillance, Epidemiology, and End Results (SEER) database. Survival curves were estimated using the Kaplan–Meier method, and Cox regression analyses were performed to evaluate the effects of clinical and pathologic variables on survival.

Results

2424 MOGCT patients with information on lymph nodes were included. Of the entire cohort, 46.2% patients received lymphadenectomy. The most common (42.2%) histologic type was teratoma, and 70.6% patients had FIGO stage I disease. Cox proportional model verified that age, grade, and log odds of positive lymph nodes (LODDS) were independent prognostic factors. Subgroup analysis showed that the association between the lymph node resection and better survival in the different age cohort.

Conclusions

Lymphadenectomy is not recommended for children (0–14 years). For patients 40 years of age and older, and for those who have the dysgerminoma type or endodermal sinus type, lymphadenectomy had an outstanding therapeutic role. As a parameter to assess lymph node status, LODDS could be used to classify MOGCTs.

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Acknowledgements

This study is sponsored by grants from Shanghai Sailing Program (No.16YF1401100 and No.19YF1404300) and Natural Science Foundation of Shanghai (No.17ZR1403500) and Natural Science Foundation of China (No.81802596).

Funding

This study was funded by Science and Technology Commission of Shanghai Municipality (grant numbers 16YF1401100 and 19YF1404300), the Natural Science Foundation of Shanghai (grant numbers 17ZR1403500), and National natural science foundation of China (81802596).

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Author notes

  1. Jieyu Wang, Ruifang Chen, Jun Li & Xin Lu

    Present address: Department of Gynecology, Obstetrics and Gynecology Hospital, Fudan University, No. 128, Shenyang Road, Yangpu District, Shanghai, 200090, China

Authors and Affiliations

  1. Shanghai Key Laboratory of Female Reproductive Endocrine-Related Disease, Fudan University, Shanghai, China

    Jieyu Wang & Xin Lu

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  1. Jieyu Wang
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Contributions

JY Wang: project development, data collection, data analysis, and manuscript writing; X Lu: project development, data management, and manuscript editing; RF Chen: project development and manuscript editing; J Li: data collection or management.

Corresponding author

Correspondence to Xin Lu.

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Conflict of interest

Author Jieyu Wang declares that she has no conflict of interest. Author Ruifang Chen declares that he/she has no conflict of interest. Author Jun Li declares that she has no conflict of interest. Author Xin Lu declares that she has no conflict of interest.

Ethical approval

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

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Informed consent was obtained from all individual participants included in the study.

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The therapeutic standards for malignant ovarian germ cell tumors are still confusing. This population-based study showed some pathological types and older age appear to be associated with the necessity of operating lymphadenectomy.

Electronic supplementary material

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404_2020_5772_MOESM1_ESM.tif

Additional Fig. 1 OS of patients divided by clinicopathologic characteristics. Endodermal sinus tumor-EST; Embryonal carcinoma-EC; Mixed germ cell tumor-MGCT; Struma ovarii-SO; Single-never married-SNM (TIF 879 kb)

404_2020_5772_MOESM2_ESM.tif

Additional Fig. 2 CSS of patients divided by clinicopathologic characteristics. Abbreviations: Endodermal sinus tumor-EST; Embryonal carcinoma-EC; Mixed germ cell tumor-MGCT; Struma ovarii-SO; Single-never married-SNM (TIF 891 kb)

Additional Table 1 The distribution of various histologies of patients in different age groups. (DOCX 20 kb)

404_2020_5772_MOESM4_ESM.docx

Additional Table 2 CSS and OS of patients with malignant germ cell tumors based on clinico-pathological characteristics (DOCX 22 kb)

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Wang, J., Chen, R., Li, J. et al. The individualized significance of lymphadenectomy across all age groups and histologies in malignant ovarian germ cell tumors. Arch Gynecol Obstet 302, 1441–1450 (2020). https://doi.org/10.1007/s00404-020-05772-3

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