Predicting postoperative recurrence and survival in malignant ovarian germ cell tumors: a single-center retrospective cohort study and nomogram development

Background: Malignant ovarian germ cell tumors (MOGCTs) are associated with a relatively good prognosis when diagnosed early and treated appropriately. However, disease recurrence significantly worsens outcomes. Therefore, identifying risk factors for recurrence is crucial for improving patient prognosis. The role of carcinoembryonic antigen (CEA) in MOGCTs remains unclear, and this study aimed to evaluate its prognostic value. Methods: This single-center retrospective study included 123 MOGCT patients treated between January 2012 and December 2024. Data on clinical characteristics, serological markers (including CEA), surgical details, and follow-up outcomes were collected. Cox proportional hazards regression analyzed risk factors for postoperative recurrence and all-cause mortality. Kaplan-Meier curves evaluated progression-free survival (PFS) and overall survival (OS). Nomograms were developed to predict the probabilities of recurrence and mortality. Results: Multivariate analysis identified that advanced International Federation of Gynecology and Obstetrics (FIGO) stage (II-IV) (HR = 5.299, P = 0.004), presence of metastasis (HR = 3.364, P = 0.015), and elevated preoperative CEA (HR = 4.237, P = 0.019) as independent risk factors for postoperative recurrence; For mortality, stage II-IV disease (HR = 5.398, P = 0.044) and elevated preoperative CEA (HR = 5.779, P = 0.012) were identified as risk factors. Predictive nomograms for recurrence and OS were successfully established. Conclusions: Tumor stage, metastasis status, and preoperative CEA level are predictive of postoperative recurrence in MOGCTs, while tumor stage and preoperative CEA level also predict postoperative OS. These findings may facilitate the identification of high-risk patients for early intervention. Further research is needed to explore the relationship between dynamic changes in CEA and the risk of recurrence. Although the routine application of CEA in MOGCTs requires more evidence, this study suggests it may serve as a potential supplementary prognostic indicator.