Abstract
Background
Vaginal malignant germ cell tumors (MGCTs), predominantly yolk sac tumors, are extremely rare, with no established consensus on optimal management. This study evaluated whether post-chemotherapy surgery is necessary for vaginal MGCTs.
Methods
A retrospective analysis was conducted on patients diagnosed with vaginal MGCTs from 1996 to 2023. Progression-free survival (PFS), overall survival (OS), the impact of surgical intervention, and the presence of post-chemotherapy residual mass (RM) were assessed.
Results
Seventy-five patients (median age:11 months) were included. Six underwent initial tumor resection, and all received platinum-based chemotherapy. RM was detected post-chemotherapy in 57% of evaluable cases (40/70), with vaginoscopy outperforming standard imaging in detection (p < 0.001). The 5-year PFS and OS rates were 83% (95%CI: 71–90) and 94% (95%CI: 84–98), respectively. Neither RM (p = 0.64) nor delayed surgical intervention (5-year PFS: 77% (95%CI: 54–90) without surgery versus 85% (95%CI: 70–92) with surgery; log-rank test p = 0.72) significantly impacted PFS.
Discussion
Neoadjuvant platinum-based chemotherapy yields excellent survival outcomes in vaginal MGCTs. Vaginoscopy appears more sensitive than standard imaging for RM detection and is recommended for post-chemotherapy evaluation. In the absence of RM on vaginoscopy and with negative tumor markers, systematic post-chemotherapy surgery may be unnecessary. A global consensual framework for managing is proposed.
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Data availability
The dataset generated and analysed during the current study is available from the corresponding author on reasonable request.
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Acknowledgements
We thank Dr. Erika Vacchelli for her assistance in writing, editing, and critically reviewing the manuscript, Dr. Daniel Orbach for connecting us with the teams in Shanghai, and Thaissa Maria Veiga Faria and Jan Kacprzak for their help in completing the data.
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Cécile Faure-Conter: Conceptualisation, resources, methodology, investigation, writing-original draft, writing-reviewing and editing. Luiz Fernando Lopes: Resources, writing, review, and editing. Yijin Gao: Resources, writing review and editing. Gabriele Calaminus: Conceptualisation, resources, writing-review and editing. Monica Terenziani: Conceptualisation, resources, writing-review and editing. Maria Debora De Pasquale: Resources, writing-review and editing. Agnes Vojcek: Resources, writing-review and editing. Velikonja Orjana: Resources, writing review and editing. Joanna Stefanowicz: Resources, writing review and editing. Shayi Jiang: Resources, writing, review, and editing. Xiaojun Yua: Resources, writing review and editing. Yali Han: Resources, writing review and editing. Ricardo López-Almaraz: Resources, writing review and editing. Anthony Penn: Resources, writing review and editing. Claire Stokes: Resources, writing-review and editing. Michelle Nuno: Resources, writing review and editing. Lindsay Frazier: Resources, writing review and editing. Deborah F. Billmire: writing-review and editing. Brice Fresneau: Resources, writing review and editing. Claire Cropet: Methodology and investigation, writing-review and editing.
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Faure-Conter, C., Lopes, L.F., Gao, Y. et al. Vaginal germ cell tumors: results from the international retrospective VAGIPED study. Br J Cancer (2025). https://doi.org/10.1038/s41416-025-03201-3
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DOI: https://doi.org/10.1038/s41416-025-03201-3
