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Prognostic factors in children with extracranial germ cell tumors treated with cisplatin-based chemotherapy.

Kim J, Lee NH, Lee SH, Yoo KH, Sung KW, Koo HH, Seo JM, Lee SK - Korean J Pediatr (2015)

Bottom Line: The 5-year EFS was lower in patients older than 10 years, (n=21, 80.0%±8.9%) compared with those younger than 10 years (n=45, 95.2%±3.3%) (P=0.04).However, nongerminomatous mediastinal tumors were associated with poor survival in children.Further research is needed to improve the prognosis of children with malignant mediastinal GCTs.

View Article: PubMed Central - PubMed

Affiliation: Department of Pediatrics, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea.

ABSTRACT

Purpose: To evaluate the outcomes and prognostic factors in children with extracranial germ cell tumors (GCTs) treated at a single institution.

Methods: Sixty-six children diagnosed with extracranial GCTs between 1996 and 2012 were included in the study. Primary treatment was surgical excision, followed by six cycles of cisplatin-based chemotherapy. The survival rates were compared according to the International Germ Cell Cancer Cooperative Group classification used for GCTs in adults to validate the classification guidelines for GCTs in children.

Results: The median patient age was 4.4 years. In 34 patients (51.5%), the primary tumor site was the gonad. Extragonadal GCTs were detected in 32 patients. The 5-year overall survival and event-free survival (EFS) were 92.0%±3.5% and 90.4%±3.7%, respectively. In univariate analysis, tumor histology, metastasis, and elevated alpha-fetoprotein were not prognostic factors in children with extracranial GCTs. However, EFS was poorer in patients with mediastinal disease (n=12, 66.7%±13.6 %) than in those with nonmediastinal disease (n=54, 96.0%±2.8%) (P=0.001). The 5-year EFS was lower in patients older than 10 years, (n=21, 80.0%±8.9%) compared with those younger than 10 years (n=45, 95.2%±3.3%) (P=0.04). Multivariate analysis identified the mediastinal tumor site as the only independent prognostic factor.

Conclusion: The prognosis of children with extracranial GCTs was favorable. However, nongerminomatous mediastinal tumors were associated with poor survival in children. Further research is needed to improve the prognosis of children with malignant mediastinal GCTs.

No MeSH data available.


Related in: MedlinePlus

(A) The 5-year event-free survival (EFS) and overall survival (OS). (B-F) The 5-year EFS according to the risk factors. *LR-histology includes mature teratoma, immature teratoma, and germinoma. HR-histology includes yolk sac tumor, choriocarcinoma, and other mixed germ cell tumors. LR, low-risk; HR, high-risk; AFP, alpha-fetoprotein.
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Figure 1: (A) The 5-year event-free survival (EFS) and overall survival (OS). (B-F) The 5-year EFS according to the risk factors. *LR-histology includes mature teratoma, immature teratoma, and germinoma. HR-histology includes yolk sac tumor, choriocarcinoma, and other mixed germ cell tumors. LR, low-risk; HR, high-risk; AFP, alpha-fetoprotein.

Mentions: The 5-year OS and EFS rates were 92.0%±3.5% and 90.4%±3.7%, respectively (Fig. 1). Relapse occurred in five patients, of whom one underwent high-dose chemotherapy and autologous stem cell rescue and is alive. The remaining four patients died from progressive disease. Univariate analysis according to the risk factors revealed no differences in the 5-year EFS between the patients with mature teratoma, immature teratoma, or germinoma (96.6%±3.4 %) and those with other histologies (84.7%±6.3%, P=0.11). AFP levels at the time of diagnosis were not correlated with prognosis (Table 2). Metastatic disease at the time of diagnosis was not a significant prognostic factor, although the 5-year EFS was 93.5%±3.6% in patients without metastases and 81.9%±9.5% in patients with metastases (P=0.16). In addition, the EFS of children with nonpulmonary visceral metastases was 90.9%±8.7%, whereas that of children with pulmonary metastases was 62.5%±21.3% (P=0.21) (Table 2). However, EFS was poorer in patients with mediastinal disease than in those with nonmediastinal disease (Table 2). The 5-year EFS was worse in patients older than 10 years of age (n=21, 80.0%±8.9%) than in those younger than 10 years of age (n=45, 95.2%±3.3%) (P=0.04). Multivariate analysis identified a mediastinal tumor site as the only independent prognostic factor (Table 3).


Prognostic factors in children with extracranial germ cell tumors treated with cisplatin-based chemotherapy.

Kim J, Lee NH, Lee SH, Yoo KH, Sung KW, Koo HH, Seo JM, Lee SK - Korean J Pediatr (2015)

(A) The 5-year event-free survival (EFS) and overall survival (OS). (B-F) The 5-year EFS according to the risk factors. *LR-histology includes mature teratoma, immature teratoma, and germinoma. HR-histology includes yolk sac tumor, choriocarcinoma, and other mixed germ cell tumors. LR, low-risk; HR, high-risk; AFP, alpha-fetoprotein.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4644767&req=5

Figure 1: (A) The 5-year event-free survival (EFS) and overall survival (OS). (B-F) The 5-year EFS according to the risk factors. *LR-histology includes mature teratoma, immature teratoma, and germinoma. HR-histology includes yolk sac tumor, choriocarcinoma, and other mixed germ cell tumors. LR, low-risk; HR, high-risk; AFP, alpha-fetoprotein.
Mentions: The 5-year OS and EFS rates were 92.0%±3.5% and 90.4%±3.7%, respectively (Fig. 1). Relapse occurred in five patients, of whom one underwent high-dose chemotherapy and autologous stem cell rescue and is alive. The remaining four patients died from progressive disease. Univariate analysis according to the risk factors revealed no differences in the 5-year EFS between the patients with mature teratoma, immature teratoma, or germinoma (96.6%±3.4 %) and those with other histologies (84.7%±6.3%, P=0.11). AFP levels at the time of diagnosis were not correlated with prognosis (Table 2). Metastatic disease at the time of diagnosis was not a significant prognostic factor, although the 5-year EFS was 93.5%±3.6% in patients without metastases and 81.9%±9.5% in patients with metastases (P=0.16). In addition, the EFS of children with nonpulmonary visceral metastases was 90.9%±8.7%, whereas that of children with pulmonary metastases was 62.5%±21.3% (P=0.21) (Table 2). However, EFS was poorer in patients with mediastinal disease than in those with nonmediastinal disease (Table 2). The 5-year EFS was worse in patients older than 10 years of age (n=21, 80.0%±8.9%) than in those younger than 10 years of age (n=45, 95.2%±3.3%) (P=0.04). Multivariate analysis identified a mediastinal tumor site as the only independent prognostic factor (Table 3).

Bottom Line: The 5-year EFS was lower in patients older than 10 years, (n=21, 80.0%±8.9%) compared with those younger than 10 years (n=45, 95.2%±3.3%) (P=0.04).However, nongerminomatous mediastinal tumors were associated with poor survival in children.Further research is needed to improve the prognosis of children with malignant mediastinal GCTs.

View Article: PubMed Central - PubMed

Affiliation: Department of Pediatrics, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea.

ABSTRACT

Purpose: To evaluate the outcomes and prognostic factors in children with extracranial germ cell tumors (GCTs) treated at a single institution.

Methods: Sixty-six children diagnosed with extracranial GCTs between 1996 and 2012 were included in the study. Primary treatment was surgical excision, followed by six cycles of cisplatin-based chemotherapy. The survival rates were compared according to the International Germ Cell Cancer Cooperative Group classification used for GCTs in adults to validate the classification guidelines for GCTs in children.

Results: The median patient age was 4.4 years. In 34 patients (51.5%), the primary tumor site was the gonad. Extragonadal GCTs were detected in 32 patients. The 5-year overall survival and event-free survival (EFS) were 92.0%±3.5% and 90.4%±3.7%, respectively. In univariate analysis, tumor histology, metastasis, and elevated alpha-fetoprotein were not prognostic factors in children with extracranial GCTs. However, EFS was poorer in patients with mediastinal disease (n=12, 66.7%±13.6 %) than in those with nonmediastinal disease (n=54, 96.0%±2.8%) (P=0.001). The 5-year EFS was lower in patients older than 10 years, (n=21, 80.0%±8.9%) compared with those younger than 10 years (n=45, 95.2%±3.3%) (P=0.04). Multivariate analysis identified the mediastinal tumor site as the only independent prognostic factor.

Conclusion: The prognosis of children with extracranial GCTs was favorable. However, nongerminomatous mediastinal tumors were associated with poor survival in children. Further research is needed to improve the prognosis of children with malignant mediastinal GCTs.

No MeSH data available.


Related in: MedlinePlus