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

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.