Can we replace adjuvant chemotherapy with surveillance for stage IA-C immature ovarian teratomas of any grade? an international multicenter analysis

Bergamini, Alice; Sarwar, Naveed; Ferrandina, Gabriella; Scarfone, Giovanna; Short, Dee; Aguiar, Xianne; Camnasio, Cristina Angela; Kaur, Baljeet; Savage, Philip; Cormio, Gennaro; Lim, Adrian; Pignata, Sandro; Mangili, Giorgia; Seckl, Michael J.

doi:10.1016/j.ejca.2020.06.033

Cited by 20 publications

(32 citation statements)

References 22 publications

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“…After eliminating the duplicates and screening the titles and abstracts, 52 studies were selected for full-text assessment ( Figure 1 ). Eventually, we included 15 studies [ 10 , 11 , 12 , 13 , 15 , 18 , 19 , 20 , 21 , 22 , 23 , 24 , 25 , 26 ] of 707 patients in our meta-analysis ( Table 1 ), of which 14 studies consisting of 435 patients reported outcomes for both the recurrence and mortality rate [ 10 , 11 , 12 , 13 , 15 , 18 , 19 , 20 , 21 , 22 , 23 , 25 , 26 ]. Importantly, we excluded 101 patients with stage IA G1 POIT and 27 patients with IA GX, IX G1, or IX GX diseases within these included studies.…”

Section: Resultsmentioning

confidence: 99%

“…However, unlike testicular germ cell tumors (TGCT), platinum-based chemotherapy, especially BEP after comprehensive staging surgery, has always been the standard treatment of MOGCTs, except for stage IA G1 POIT and stage I dysgerminoma [ 5 , 6 ]. Researchers have evaluated the safety of extending surveillance to stage IA-IC POIT of any grade [ 10 , 11 , 12 , 13 , 25 ]. Nonetheless, most of these studies enrolled various histological types of MOGCTs, and the division of subgroups between the FIGO stage and WHO grade differed, weakening the strength to support active surveillance in all stage I POIT patients.…”

Section: Discussionmentioning

confidence: 99%

“…Additionally, in pediatric POIT, surveillance in stage I of any grade is recommended and has been proven to be safe as well as to reduce chemotherapy-related adverse events [ 7 , 8 , 9 ]. Recently, a series of studies proposed that active surveillance may be acceptable in stage IA-IC POIT of any grade, regardless of whether patients are pediatric or adult [ 10 , 11 , 12 , 13 , 14 , 15 ]. Nonetheless, most of these studies have evaluated pediatric and adult patients together or included patients with different pathological subtypes of MOGCTs [ 12 , 13 , 15 ].…”

Section: Introductionmentioning

confidence: 99%

“…Nonetheless, most of these studies have evaluated pediatric and adult patients together or included patients with different pathological subtypes of MOGCTs [ 12 , 13 , 15 ]. Furthermore, due to the relatively small sample size and retrospective nature, the evidence favoring surveillance or adjuvant chemotherapy in each corresponding tumor stage (IA, IB, IC) and grade (G1, G2, G3) is insufficient [ 10 , 11 ]. The significance of postoperative adjuvant chemotherapy in patients with stage I POIT, except IA G1, still needs to be explored.…”

Section: Introductionmentioning

confidence: 99%

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Role of Adjuvant Chemotherapy in Stage I Pure Ovarian Immature Teratoma: A Systematic Review and Meta-Analysis

Wang

Zhang

et al. 2023

Cancers

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To determine the role of adjuvant chemotherapy in stage IA G2-3 and stage IB-IC pure ovarian immature teratoma (POIT), we performed a systematic review and meta-analysis by searching PubMed, Embase, Cochrane library, Web of Science, and ClinicalTrials.gov. Randomized controlled trials or cohort studies on stage IA G2-G3 or stage IB-IC POIT between 1 January 1970 and 15 December 2022 were enrolled. The recurrence rate and mortality rate were the primary outcomes, and subgroup analysis based on the tumor stage and grade was also conducted. In total, 15 studies with 707 patients were included. Compared with surveillance, adjuvant chemotherapy significantly decreased the mortality rate (RR 0.31, 95% CI 0.11–0.88, p = 0.03), but not recurrence (RR 0.74, 95% CI 0.39–1.42, p = 0.37), in the overall population. Subgroup analysis showed no statistical difference in the recurrence rate and mortality rate between patients who received adjuvant chemotherapy and surveillance in pediatric POIT, stage IA G2-3 POIT, stage IB-IC POIT, and stage IA-IC G3 POIT (all with p > 0.05). However, patients who underwent adjuvant chemotherapy appeared to have a lower risk of both recurrence (RR 0.17, 95% CI 0.03–0.83, p = 0.03) and death (RR 0.04, 95% CI 0.00–1.00, p = 0.05) in adult POIT. Adjuvant chemotherapy significantly decreased the mortality rate in patients with stage I POIT and lowered the risk of recurrence in the adult subgroup. Surveillance administered in stage I POIT over IA G1 should be cautious, especially in adult patients.

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Section: Resultsmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Role of Adjuvant Chemotherapy in Stage I Pure Ovarian Immature Teratoma: A Systematic Review and Meta-Analysis

Wang

Zhang

et al. 2023

Cancers

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“…The proportions of primitive immature neuroectodermal tissue present in PDTs are correlated with the tumor grade and prognosis (3). A majority of patients with grade 2/3 PDTs at stage I would experience a favorite prognosis after chemotherapy treatment (4,5). However, some patients are at high risk of metastasis, particularly those with high grade and stage, requiring a better understanding to improve the therapeutic outcomes.…”

Section: Introductionmentioning

confidence: 99%

Characterization of immature ovarian teratomas through single-cell transcriptome

Cao

Deng²,

Deng³

et al. 2023

Front. Immunol.

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IntroductionImmature ovarian teratomas are a type of malignant germ cell tumor composed of complicated cell types and are characterized by pathological features of immature neuroectodermal tubules/rosettes. However, there is a lack of understanding of patient-derived immature ovarian teratomas (PDT) at the single cell level. Moreover, whether stem cell lines derived from immature teratomas (CDT) can be used as models for research on PDT remains to be elucidated.MethodsSingle-cell RNA sequencing (scRNA-seq) and subsequent bioinformatic analysis was performed on three patient-derived immature ovarian teratomas (PDT) samples to reveal the heterogeneity, evolution trajectory, and cell communication within the tumor microenvironment of PDT. Validations were conducted in additional seven samples through multiplex immunofluorescence.ResultA total of qualified 22,153 cells were obtained and divided into 28 clusters, which can match to the scRNA-seq annotation of CDT as well as human fetal Cell Atlas, but with higher heterogeneity and more prolific cell-cell crosstalk. Radial glia cells (tagged by SOX2) and immature neuron (tagged by DCX) exhibited mutually exclusive expression and differentiated along distinct evolutionary trajectory from cycling neural progenitors. Proportions of these neuroectodermal cell subtypes may play important roles in PDT through contributing to the internal heterogeneity of PDTs. Moreover, the immune cells in PDTs were infiltrated rather than teratoma-derived, with more abundant macrophage in immature neuron than those in radial glia cells, and the infiltrated macrophage subtypes (i.e., M1 and M2) were significantly correlated to clinical grade. Overall, suppressed evolution process and transcriptome regulation in neuroectodermal cells, reduced cell-cell crosstalk, higher M1/M2 proportion ratio, and enhanced T cell effects in tumor microenvironment are enriched in patients with favorable prognosis.DiscussionThis study provides a comprehensive profile of PDT at the single cell level, shedding light on the heterogeneity and evolution of neuroectodermal cells within PDTs and the role of immune cells within the tumor microenvironment. Also, our findings highlight the potential usage of CDTs as a model for research on PDT.

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Malignant ovarian germ cell tumors

Shafer¹,

Gershenson²,

Hodgson³

et al. 2023

Diagnosis and Treatment of Rare Gynecologic Cancers

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Can we replace adjuvant chemotherapy with surveillance for stage IA-C immature ovarian teratomas of any grade? an international multicenter analysis

Cited by 20 publications

References 22 publications

Role of Adjuvant Chemotherapy in Stage I Pure Ovarian Immature Teratoma: A Systematic Review and Meta-Analysis

Role of Adjuvant Chemotherapy in Stage I Pure Ovarian Immature Teratoma: A Systematic Review and Meta-Analysis

Characterization of immature ovarian teratomas through single-cell transcriptome

Malignant ovarian germ cell tumors

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