Young and overlooked: malignant ovarian germ cell tumours in a West African cohort

Abstract

Abstract Introduction Malignant ovarian germ cell tumours (mOGCTs) are rare but highly curable ovarian neoplasms when diagnosed and treated promptly. However, evidence comparing yolk sac tumour (YST)-associated and non-YST mOGCTs in sub-Saharan Africa remains limited. We compared the clinicopathological characteristics, treatment patterns, and survival outcomes of women with YST-associated and non-YST mOGCTs managed at a major referral centre in Ghana. Methods We conducted a retrospective cohort study of women with histologically confirmed mOGCTs presented at a multidisciplinary gynaecologic oncology tumour board between 2013 and 2024. Demographic, clinicopathological, treatment, and survival data were extracted from a prospectively maintained database. Patients were classified according to the presence or absence of a YST component. Overall survival was estimated using the Kaplan–Meier method and compared using the log-rank test. Results Fifty-eight women were included (median age, 22 years; interquartile range [IQR], 15–45), of whom 58.6% were nulliparous. YST-associated tumours accounted for 41.4% (n = 24) of cases and occurred in significantly younger women than non-YST tumours (median age, 18.5 vs 35.5 years; p = 0.001). Women with YST-associated tumours more frequently presented with International Federation of Gynaecology and Obstetrics (FIGO) stage III–IV disease (69.6% vs 38.5%; p = 0.004) and were more likely to receive no cancer-specific treatment (25.0% vs 2.9%; p = 0.010). Only 13.8% underwent computed tomography (CT) scan for pre-treatment staging. Alpha-fetoprotein (AFP) levels were significantly higher in YST-associated tumours, whereas serum lactate dehydrogenase (LDH) levels were higher in non-YST tumours. The median surgery-to-chemotherapy interval was 105.5 days, and 61.1% (n = 11) of chemotherapy recipients had residual, recurrent, or metastatic disease at treatment initiation. Median overall survival was 14.4 months (95% CI, 8.7–27.3), with a 3-year survival of 29.5%. Three-year survival was significantly lower in women with YST-associated tumours than in those with non-YST tumours (12.5% vs 41.9%; log-rank p = 0.003). Conclusion mOGCTs in this cohort were characterised by a high prevalence of YST-associated tumours, advanced-stage presentation, delayed initiation of chemotherapy, and poor survival. Strengthening early referral, improving access to staging investigations and immunohistochemistry (IHC), and reducing surgery-to-chemotherapy delays may improve outcomes in resource-limited settings.

The authors' abstract, as published at the source. BMC Cancer, 2026 · DOI ↗