Prognostic factors for ovarian immature teratoma and significance of alpha-fetoprotein in recurrent cases
To analyze clinical characteristics of ovarian immature teratoma patients and to explore prognostic factors of recurrence-free survival. Fifty-eight cases with ovarian immature teratoma who underwent surgery in Fudan University Shanghai Cancer Center from January 2008 to January 2023, were retrospectively analyzed. The potential risk factors of recurrence were investigated. Subgroup analysis was conducted in stage I patients and in recurrent cases. The median age of diagnosis was 24.5 years (range, 7∼40 years), twenty-eight patients relapsed after a median follow-up of 72.3 months, with a 5-year recurrence-free survival and disease-specific survival rate of 81.0 % and 89.7 %, respectively. Multivariate analysis showed that adjuvant chemotherapy (HR = -1.556, 95 %CI 0.056∼0.793, P = 0.021), stage II-III (HR = 1.549, 95 %CI 1.572∼14.086, P = 0.006) and unknown residual lesions (HR = 1.591 95 %CI 1.602∼15.039P = 0.005) were risk factors of recurrence. Subgroup analysis was conducted in 32 stage I patients, the recurrence-free survival rate between adjuvant chemotherapy and surveillance group were statistically significant (P < 0.05). There was significant difference in AFP level between 15 cases with immature recurrence and 10 cases with mature recurrence(P = 0.015), a cut-off value of 25.67 ng/ml was found to be predictive for immature recurrence of ovarian immature teratoma with an area under the curve of 0.793, sensitivity and specificity were 53.3 % and 100 %, respectively. Adjuvant chemotherapy, stage II-III and unknown residual lesions were the prognostic factors for ovarian immature teratoma. Surveillance is not a substitute for adjuvant chemotherapy in stage I patients of any grade. Serum AFP level exceeding 25.67 ng/ml can be a predictor of immature recurrence.