4.6 Article

Prognostic significance of an early decline in serum alpha-fetoprotein during chemotherapy for ovarian yolk sac tumors

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GYNECOLOGIC ONCOLOGY
卷 142, 期 3, 页码 452-457

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ACADEMIC PRESS INC ELSEVIER SCIENCE
DOI: 10.1016/j.ygyno.2016.07.005

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Alpha-fetoprotein; BEP; Endodermal sinus tumor; Malignant ovarian germ cell tumor; Chemotherapy; Germ cell tumor

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Background. The ovarian yolk sac tumor (OYST) is a very rare malignancy arising in young women. Our objective was to determine whether an early decline in serum alpha-fetoprotein (AFP) during chemotherapy has a prognostic impact Methods. This retrospective study is based on prospectively recorded OYST cases at Gustave Roussy (Cancer Treatment Center). Survival curves were estimated using the Kaplan-Meier method. The serum AFP decline was calculated with the formula previously developed and validated in male patients with poor prognosis non-seminomatous germ cell tumors. Univariate and multivariate analyses were performed using the log-rank test and logistic regression, respectively. Results. Data on AFP were available to calculate an early AFP decline in 57 patients. All patients had undergone surgery followed by chemotherapy. The 5-year overall survival (OS) and event-free survival (EFS) rates were 86% (95% CI: 74%-93%) and 84% (95% CI: 73%-91%), respectively. The disease stage, presence of ascites at presentation, use of the BEP regimen, serum AFP half-life and an early AFP decline were significantly predictive factors for OS and EFS in the univariate analysis. The OS rate was 100% and 49% (95% CI: 26%-72%) in patients with a favorable AFP decline and in those with an unfavorable decline, respectively (p <0.001). In the multivariate analysis, only the presence of ascites at diagnosis (RR = 73, p = 0.03) and an unfavorable early AFP decline (RR = 16.9, p <0.01) were significant negative predictive factors for OS. Conclusions. An early AFP decline during chemotherapy is an independent prognostic factor in patients with OYSTs. (C) 2016 Elsevier Inc. All rights reserved.

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