Purpose: To evaluate the significance of meticulous surgical staging, and whether type of initial surgery or adjuvant therapy impacted on survival in cases of pure ovarian dysgerminoma.
Methods: Retrospective chart review of 45 patients treated for pure ovarian dysgerminoma at a single institute. Survival analysis with the Kaplan Meier and log rank test and the chi-square test for the comparison of categorical variables were used.
Results: Of the 45 patients subjected to a surgical staging procedure 30 (67%) had stage I disease, 2 (4%) had stage II, 9 (20%) had stage III, and 4 (9%) had stage IV pure ovarian dysgerminoma. Thirteen of these 45 patients were referred to have seemingly stage I disease. Restaging within 2 months proved stage IIIC disease in 3 (23%) of them. With a median follow-up of 61 months, the overall survival rate for ovarian dysgerminoma in this series was 84%. Significantly lower survival rates were found in patients with advanced stage (stage III-IV) ovarian dysgerminoma (53.9%), when compared with earlier stages (96.9%). Twenty-one patients with unilateral disease and fertility desire were treated with conservative surgery, 19 patients with nonconservative surgery, and in 5 suboptimal debulking could be carried out. As regards recurrence or survival rate, no significant difference was found between patients who were treated conservatively or nonconservatively, whether or not adjuvant chemotherapy or radiotherapy was given. Of the 21 patients treated with conservative surgery, 11 (52%) achieved one or more pregnancies.
Conclusion: After careful surgical staging and confirming unilateral disease, conservative surgery, followed if necessary by adjuvant chemotherapy, seems to be the ideal treatment in cases of pure ovarian dysgerminoma.