Significance of the Complete Surgical Staging of Stage I Malignant Ovarian Germ Cell Tumors

The aim of this study was to evaluate the role of complete surgical staging of a malignant ovarian germ cell tumor (MOGCT) that is apparently confined to the ovaries. This retrospective study included 135 patients with stage I MOGCT after surgery. Patients who were categorized with stage I disease without complete staging operation were staged as IX. Statistical analysis was performed using Chi-squared or Fisher's exact tests and a Cox proportional hazards model. Eighty-six patients (62.7 %) underwent a complete staging operation; 43 had stage IA disease, 3 had stage IB disease, and 40 had stage IC disease. Forty-nine patients (36.3 %) were staged as IX. After surgery, 93 patients (68.8 %) received adjuvant chemotherapy. In the observation group, the recurrence rates were 12.5 % (2/16), 14.3 % (1/7), and 47.4 % (9/19) for stage IA-IB, stage IC, and stage IX disease, respectively (stage IA-IB vs. stage IX, p = 0.035; stage IC vs. stage IX, p = 0.190). In the adjuvant chemotherapy group, the recurrence rates were 6.7 % (2/30), 6.1 % (2/33), and 6.7 % (2/30) for stage IA-IC, stage IC, and stage IX disease, respectively (stage IA-IC vs. stage IX, p > 0.999; stage IC vs. stage IX, p > 0.999). In multivariable survival analysis, complete surgical staging was significantly associated with improved disease-free survival in patients with stage I MOGCT (odds ratio 3.2; 95 % confidence interval 1.1-9.9; p = 0.049). Complete surgical staging is independently associated with prognosis in women with apparently early MOGCT who did not receive adjuvant chemotherapy. To enter surveillance strategy without adjuvant chemotherapy, complete surgical staging is mandatory.