Advanced ovarian yolk sac tumor: Upfront surgery or neoadjuvant chemotherapy followed by interval debulking?

OBJECTIVE To compare the surgery and survival outcomes between neoadjuvant chemotherapy and primary debulking surgery in patients with advanced ovarian yolk sac tumor (OYST). METHODS In this retrospective cohort analysis, patients with stage III to IV OYST or mixed germ cell tumor containing yolk sac tumor elements and underwent surgery at Peking Union Medical College Hospital between 2010 and 2021 were identified. Nineteen cases were treated with neoadjuvant chemotherapy (NACT) followed by interval surgery. Twenty-one cases were treated with primary debulking surgery (PDS). Data on patient characteristics, treatment and survival were analyzed between the two groups. RESULTS After NACT, the physical status of patients were significantly improved and tumor burden were decreased, with an optimal cytoreduction rate of 100% at interval surgery. No statistical difference was found in 3-year disease-free survival (DFS) and overall survival (OS) between NACT group and PDS group (Log Rank p =0.461 and 0.935). Patients suffered less blood loss, lower rate of transfusion, shorter operation time, and less severe peri-operative complications at the debulking surgery after NACT, as compared to patients who underwent PDS. CONCLUSION For patients with advanced stage OYST, NACT followed by interval surgery might be an alternative option, especially for those who could not tolerate the primary debulking surgery because of high tumor burden and vulnerable status.