Nasioudis D, et al. - This study sought to determine the prevalence and safety of uterine preservation among premenopausal women diagnosed with a malignant ovarian germ-cell tumor (MOGCT) of advanced stage (stage II-IV). Researchers identified no association between uterine preservation and decreased survival. They recommended considering uterine preservation in women with advanced stage Germ cell tumors interested in future fertility.

Methods

• Researchers searched the National Cancer Database and identified a cohort of women aged < 40 years, diagnosed with a MOGCT.
• They selected those with stage II-IV disease who underwent cancer-directed surgery and received chemotherapy for further analysis.
• They assessed the performance of hysterectomy from site-specific surgery codes.
• They determined an overall survival (OS) following generation of Kaplan-Meier curves; these were then compared with the log-rank test.
• They constructed a Cox multivariate model to control for possible confounders.

Results

• Researchers identified a total of 526 eligible patients; rate of hysterectomy was 20.2%.
• In this study, women who had a hysterectomy were older (median age 30.5 vs 20 years, p < 0.001) and more likely to present with bilateral tumors (12.6% vs 3.8%, p < 0.001).
• There appeared no differences based on tumor histology (p = 0.67).
• For those with stage II, III and IV disease, rate of uterine preservation was 82.8%, 79.5% and 75% respectively (p = 0.46).
• Observations revealed no difference in OS between women who had hysterectomy and those who did not (p = 0.051); five-year OS rates were 87.1% and 94.4% respectively.
• After controlling for disease stage, tumor histology and patient race, there appeared no association of uterine preservation with a decreased survival (HR: 0.59, 95% CI: 0.28, 1.24, p = 0.19).