Impact of lymphadenectomy on survival outcomes for stage I malignant ovarian germ cell tumors.

OBJECTIVE

Malignant ovarian germ cell tumors (MOGCTs) are rare non-epithelial ovarian malignancies. Although comprehensive surgical staging, including lymphadenectomy, is recommended by current guidelines, the prognostic benefit in early-stage disease remains uncertain. We evaluated patterns of lymphadenectomy use and its association with survival in stage T1 MOGCTs.

METHODS

Using the National Cancer Database, we identified women with stage T1 MOGCTs diagnosed between 2018 and 2022. Multivariable log-linear regression was used to identify factors associated with lymphadenectomy. Propensity score inverse probability of treatment weighting (IPTW) was applied to estimate the association between lymphadenectomy and survival using weighted Kaplan-Meier and Cox proportional-hazards models.

RESULTS

Among 740 patients, 47.3% underwent lymphadenectomy, with use declining from 53.3% in 2018 to 36.2% in 2022 (P = 0.02). Dysgerminoma histology (aRR 1.78, 95% CI: 1.19-2.66), larger tumor size (>150 mm, aRR 1.44, 95% CI: 1.03-2.01), and performance of hysterectomy (aRR 1.40, 95% CI: 1.04-1.87) were associated with increased likelihood of undergoing lymphadenectomy. The median number of nodes examined was 9 (IQR 4-16), with nodal metastases identified in 6.6% of cases, most commonly among dysgerminomas. After PS IPTW, patients who underwent lymphadenectomy were more likely to receive adjuvant chemotherapy (52.8% vs. 44.7%; SMD = 0.16), and lymphadenectomy was not associated with improved survival (aHR 1.23, 95% CI: 0.38-4.06).

CONCLUSIONS

In stage T1 MOGCTs, lymphadenectomy was not associated with improved survival but was associated with higher rates of adjuvant chemotherapy use. Given the low rate of nodal metastasis and excellent survival outcomes, a selective approach to lymphadenectomy may be appropriate.