Objective
Ovarian germ cell cancers comprise 3-5% of all ovarian malignancies. Patients with yolk sac tumors have a worse prognosis compared to those with dysgerminomas or immature teratomas. Due to the rarity of yolk sac tumors, few studies have evaluated their distinct demographic and clinicopathologic features. Previous studies have demonstrated that Asians and blacks have an increased incidence of germ cell cancers. We propose to determine the factors associated with the presentation and survival rates of ovarian yolk sac cancer patients.
Results
Of 423 patients, the median age was 22 (range 1-91) years. In all, 51.3% were white, 16.5% black, 15.6% Hispanic, 15.6% Asian, and 1% other. Although Asians comprise only 5% of the US population, they constitute >15% of yolk sac cancer patients in this study ( Figure ). Of 193 patients with detailed primary surgery information, 149 (77.2%) had fertility-sparing surgeries. Of those with pathology data, 54% had stage I, 6% stage II, 28% stage III, and 12% stage IV disease. Grade 1, 2, and 3 disease was found in 8%, 13%, and 79% of patients, respectively. The overall 5-year disease-specific survival (DSS) was 86.9%. The DSS of younger women (age <22 years, median) was 91.4% compared to 82.4% of older patients ( P < .01). The DSS improved over 3 time periods from the years 1973 through 1986, 1987 through 1999, and 2000 through 2012 with corresponding survival rates of 74%, 85.1%, and 92.1% ( P < .01). The DSS of Asians was 95.1% compared to 85.7% for whites, 85.6% for Hispanics, and 82.9% for blacks ( P = .2). Stage I, II, III, and IV disease patients had associated DSS of 91.9%, 100%, 93%, and 76.7%, respectively ( P = .03). Those who had fertility-sparing surgeries had DSS of 95.7% compared to 80.7% for those after nonfertility-sparing surgery ( P < .01). In multivariate analysis, younger age (<22 years) and lower stage of disease (I and II) were independent predictors associated with improved DSS (age: hazard ratio, 0.53; 95% confidence interval, 0.29–0.99; P = .05; and stage: hazard ratio, 0.18; 95% confidence interval, 0.07–0.44; P < .001).
