A. Waters1, I. Maizlin1, K. Gow2, M. Langer5, M. Goldfarb3, J. Nuchtern4, S. Vasudevan4, A. Goldin2, M. Ravul7, J. Doski6, E. Beierle1 1University Of Alabama At Birmingham,Pediatric Surgery,Birmingham, AL, USA 2University Of Washington,Surgery,Seattle, WA, USA 3Providence Saint John’s Health Center,Surgery,Santa Monica, CA, USA 4Baylor College Of Medicine,Surgery,Houston, TX, USA 5Maine Medical Center,Surgery,Portland, ME, USA 6University Of Texas Health Science Center At San Antonio,Surgery,San Antonio, TX, USA 7Emory University School Of Medicine,Surgery,Atlanta, GA, USA
Introduction: Yolk sac tumors (YST) of the ovary are malignant tumors frequently diagnosed in teenagers and young adults. Publications have demonstrated an association between stage of disease and mortality. However, it is not clear what effect age at diagnosis has on ovarian YST prognosis. We queried the National Cancer Data Base to determine if age at diagnosis is a prognostic factor for overall survival (OS) in ovarian YST patients.
Methods: The NCDB (1998-2012) was reviewed for cases. Patients were stratified by age at diagnosis into ≤15, 16-25, 26-40, and ≥41 years. Log-rank test was used to compare survival. Demographics, presence of comorbidities, tumor characteristics, diagnostic periods, treatments, and survival rates were compared using pooled variance t-tests and x ², followed by multivariate Cox proportional hazard model (α=0.05).
Results:Of 229,194 patients in the ovarian NCDB, there were 721 patients with ovarian YST. Patients were grouped according to age at diagnosis (≤15 years: N=156; 16-25: N=267; 26-40: N=175; ≥41: N=123). Race, socioeconomic status, and comorbidities were similar across groups. The time between diagnosis and staging (p=0.511), initiation of treatment (p=0.616), and definitive surgical procedure (p=0.068) were similar. Incidents of local tumor extension increased with age, with children ≤15 years more likely to be diagnosed with tumor confined to the ovary (T1 disease) compared to women >41 (60.4% vs 40.7%, p=0.002). Similar results were found comparing metastases: 9.7% of patients ≤15 had metastatic disease, as opposed to 30.2% of those ≥41 (p<0.001). Consequently, increase in age appeared to be associated with higher overall neoplasm stage at presentation, with patients ≤15 having 51.3% stage I and 12.2% stage IV while patients ≥41 had 32.9% and 25.7% respectively (p<0.001). In multivariate analysis, accounting for demographics, socioeconomic factors, presence of comorbidities, treatment modalities and stage of disease, only age and stage affected survival. Cox regression demonstrated increase in stage to be correlated with decrease in OS (p=0.002, HR=1.398, 1.928, 2.308 for each successive stage beyond the first). Controlling for effect of stage, OS was significantly higher in the younger age group and decreased chronologically with age (p<0.001; HR=1.083, 2.202 and 8.030 for each successive age group compared to the youngest age group).
Conclusion:The results confirmed that increase in stage of disease negatively affects survival in ovarian YST. They also suggest that an earlier age at diagnosis of ovarian YST correlates with decreased rates of mortality. Therefore, age at diagnosis may be used as evidence-based risk stratification for prognosis.
