Early administration of adjuvant chemotherapy for patients with advanced-stage malignant ovarian germ cell tumors is associated with an overall survival benefit
Malignant ovarian germ cell tumors are chemosensitive but also characterized by a rapid tumor growth. This study aimed to evaluate the impact of delay on adjuvant chemotherapy administration on the survival of patients with advanced-stage malignant ovarian germ cell tumors who underwent primary surgery. The National Cancer Database was accessed, and patients diagnosed between 2004 and 2015 with stage III to IV malignant ovarian germ cell tumors who underwent primary surgery and received adjuvant chemotherapy were identified. Clinico-pathologic characteristics and overall survival were compared between patients who received adjuvant chemotherapy 1 to 4 weeks (early administration group) and 4.1 to 12 weeks (delayed administration group). Overall survival was compared with the log-rank test after generation of Kaplan-Meier curves. A Cox model was constructed to control for a priori selected confounders. A total of 622 patients were identified; the median time interval between primary surgery and adjuvant chemotherapy was 25 days (interquartile range 18). Delay in adjuvant chemotherapy administration occurred for 229 patients (36.8%). Patients in the early administration group were younger (median age 22 vs 24 years, p < .001). There were no differences between the two groups in terms of patient race, insurance status, presence of medical co-morbidities, tumor histology, and disease stage. Delay in adjuvant chemotherapy administration was associated with worse overall survival (p = .004; 5-year overall survival rates were 77.6% and 87.5%, respectively). After controlling for confounders, delay in adjuvant chemotherapy administration was associated with worse overall survival (hazard ratio 1.99, 95% confidence interval 1.34 to 3.01). For patients with advanced-stage malignant ovarian germ cell tumors, especially those with non-dysgerminoma histology, early administration of adjuvant should be strongly considered because delay may be associated with a detrimental impact on overall survival.