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Al-Khayal A, Noureldin Y, Alghafees M, Shafqat A, Sabbah BN, Elhossiny AH, Bakir M, Omar MA, Arabi TZ, Abdul Rab S, Alsaikhan B, Aldhalaan R, Alquirnas M, Alrabeeah K. A decade in focus: mixed germ cell tumors with choriocarcinoma components. Ann Med Surg (Lond) 2023; 85:5355-5358. [PMID: 37915675 PMCID: PMC10617832 DOI: 10.1097/ms9.0000000000001314] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2023] [Accepted: 09/06/2023] [Indexed: 11/03/2023] Open
Abstract
Introduction This 10-year registry review aimed to investigate the clinical behaviour and outcomes of mixed germ cell tumours with choriocarcinoma components, a rare and aggressive subtype of testicular cancer, in Saudi Arabia. The study explores the demographic characteristics of affected patients, tumour profiles, and the mortality rate associated with this malignancy. Methods Utilizing data from the Saudi Cancer Registry, the authors identified 33 cases of mixed germ cell tumours with choriocarcinoma components among 1001 testicular cancer cases recorded between 2008 and 2017. Demographic information, including age, marital status, region of residency, year of diagnosis, and 10-year survival status, were collected. Tumour factors, such as the basis of diagnosis, origin site, behaviour, grade, extension, and laterality, were also analyzed. Results The majority of cases (78.8%) occurred in the young age group (18-45 years), and most tumours (97%) originated in normally descended testes. Grade IV (undifferentiated anaplastic) tumours and distant metastasis were present in 45.5% of patients. All cases exhibited malignant tumour behaviour. The overall mortality rate was 15%, with a mean time from diagnosis to death of 7.72 months (range: 0.5-21.5 months). Conclusion Mixed germ cell tumours with choriocarcinoma components are rare and tend to affect younger populations. These tumours demonstrate aggressive clinical behaviour, with a significant proportion presenting with high-grade lesions and metastasis at diagnosis. The observed mortality rate underscores the poor prognosis associated with this malignancy. Our study provides essential insights into the clinical characteristics of this rare tumour subtype in the Saudi Arabian population, emphasizing the need for further research to identify prognostic factors and optimize management strategies for affected patients.
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Affiliation(s)
- Abdullah Al-Khayal
- Department of Urology, King Abdulaziz Medical City
- College of Medicine, King Saud bin Abdulaziz University for Health Sciences
- King Abdullah International Medical Research Center
| | | | - Mohammad Alghafees
- College of Medicine, King Saud bin Abdulaziz University for Health Sciences
| | - Areez Shafqat
- College of Medicine, Alfaisal University, Riyadh, Saudi Arabia
| | | | | | - Mohamad Bakir
- College of Medicine, Alfaisal University, Riyadh, Saudi Arabia
| | | | | | | | - Bader Alsaikhan
- Department of Urology, King Abdulaziz Medical City
- College of Medicine, King Saud bin Abdulaziz University for Health Sciences
- King Abdullah International Medical Research Center
| | - Reema Aldhalaan
- College of Medicine, Alfaisal University, Riyadh, Saudi Arabia
| | - Muhannad Alquirnas
- College of Medicine, King Saud bin Abdulaziz University for Health Sciences
| | - Khalid Alrabeeah
- Department of Urology, King Abdulaziz Medical City
- College of Medicine, King Saud bin Abdulaziz University for Health Sciences
- King Abdullah International Medical Research Center
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Pastorino U, Leuzzi G, Sabia F, Girotti P, Duranti L, Radaelli S, Fiore M, Stacchiotti S, Patrizia G, Salvioni R, Gronchi A. Long term outcome of complex surgical resection and reconstruction for rare thoracic cancers. TUMORI JOURNAL 2023; 109:450-457. [PMID: 36797831 PMCID: PMC10540492 DOI: 10.1177/03008916231154763] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2022] [Revised: 01/09/2023] [Accepted: 01/17/2023] [Indexed: 02/18/2023]
Abstract
BACKGROUND Complex surgical resection and reconstruction for rare thoracic cancers (RTCs) represent a major challenge, given their very low frequency, extreme variability of presentation, multi-modality treatment options and inadequate outcome prediction. We analysed the experience of a tertiary referral centre on a consecutive series of patients with thoracic germ cell tumours, thymomas and sarcomas, with the aim of reporting the long-term outcome by cancer type and complexity of surgical procedures. METHODS From Jan 2003 to Dec 2018, 768 surgical procedures were performed with curative intent on 644 RTC patients. Study endpoints were: post-operative hospital stay (Pod), 30-day and 90-day mortality, 5-year and 10-year overall survival (OS). Median follow-up of alive patients was 7.2 years. RESULTS Median Pod was 7 days, with a 1.2% 30-day and 2.9% 90-day mortality. OS was 90.8% at one year, 74.2% at five years and 62.8% at 10 years. Ten-year OS was 73.0% in low, 65.3% in intermediate, and 55.6% in high complexity score (Log-rank tests p<0.0001); 66.6% in patients with one or two reconstructions and 46.4% in patients with three or more reconstructions (p<0.0001); 46.0% with vascular and 50.0% with chest wall reconstruction; 71.8% in germ cell tumours, 64.6% in thymoma and 51.3% in sarcoma (p<0.0001). CONCLUSION Complex surgical resection and reconstruction was associated with acceptable 90-day mortality and good 10-year survival in all RTC types. A predictive score based on surgical complexity and cancer type can help the clinical decision making.
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Affiliation(s)
- Ugo Pastorino
- Department of Surgery, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Giovanni Leuzzi
- Department of Surgery, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Federica Sabia
- Department of Surgery, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Paolo Girotti
- Department of General and Thoracic Surgery, Landeskrankenhaus Feldkirch, Feldkirch, Austria
| | - Leonardo Duranti
- Department of Surgery, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Stefano Radaelli
- Department of Surgery, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Marco Fiore
- Department of Surgery, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Silvia Stacchiotti
- Department of Cancer Medicine, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Giannatempo Patrizia
- Department of Cancer Medicine, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Roberto Salvioni
- Department of Surgery, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Alessandro Gronchi
- Department of Surgery, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
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Leng C, Cui Y, Mai Z, Chen R, Yuan J, Wang K, Wen J, Fu J, Liu Q. Analysis of prognostic factors and establishment of prognostic model for primary mediastinal germ cell tumors: a case controlled study. Int J Surg 2023; 109:2574-2584. [PMID: 37222675 PMCID: PMC10498837 DOI: 10.1097/js9.0000000000000507] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2023] [Accepted: 05/10/2023] [Indexed: 05/25/2023]
Abstract
BACKGROUND The overall prognosis of primary mediastinal germ cell tumors (PMGCTs) is poor and the associated prognostic factors are not fully understood. Our goal was to investigate the prognostic factors of PMGCTs and to develop a validated prognostic prediction model. MATERIALS AND METHODS A total of 114 PMGCTs with specific pathological types were included in this study. Clinicopathological characteristics of nonseminomatous PMGCTs and mediastinal seminomas were compared using the χ2 or Fisher's exact test. Independent prognostic factors of nonseminomatous PMGCTs screened using the univariate and multivariate Cox regression analysis were then used to generate a nomogram. The predictive performance of the nomogram was evaluated using the concordance index, decision curve, and the area under the receiver operating characteristic curve (AUC) and validated by bootstrap resampling. The Kaplan-Meier curves of independent prognostic factors were analyzed. RESULTS This study included 71 cases of nonseminomatous PMGCTs and 43 cases of mediastinal seminomas. The 3-year overall survival rates for nonseminomatous PMGCTs and mediastinal seminomas patients were 54.5 and 97.4%, respectively. The overall survival prognostic nomogram for nonseminomatous PMGCTs was established by integrating independent prognostic factors, including the Moran-Suster stage, white blood cell, hemoglobin, and platelet-lymphocyte ratio. The nomogram demonstrated good performance with a concordance index of 0.760 and the 1-year and 3-year AUC values of 0.821 and 0.833, respectively. These values were better than those of the Moran-Suster stage system. The bootstrap validation had an AUC of 0.820 (0.724-0.915) and showed a well-fitting calibration curve. Besides, patients with mediastinal seminomas showed favorable clinical outcomes and all the nine patients received neoadjuvant therapy and postoperative surgery achieved pathological complete response. CONCLUSION A nomogram based on staging and blood routine examination results was established to accurately and consistently predict the prognosis of patients with nonseminomatous PMGCTs.
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Affiliation(s)
- Changsen Leng
- State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Sun Yat-sen University Cancer Center, Guangzhou, China
- Department of Thoracic Surgery, Sun Yat-sen University Cancer Center, Guangzhou, China
- Guangdong Esophageal Cancer Institute, Guangzhou, China
| | - Yingying Cui
- State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Sun Yat-sen University Cancer Center, Guangzhou, China
- Department of Hematologic Oncology, Sun Yat-sen University Cancer Center, Guangzhou, China
| | - Zihang Mai
- State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Sun Yat-sen University Cancer Center, Guangzhou, China
- Department of Thoracic Surgery, Sun Yat-sen University Cancer Center, Guangzhou, China
- Guangdong Esophageal Cancer Institute, Guangzhou, China
| | - Rui Chen
- State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Sun Yat-sen University Cancer Center, Guangzhou, China
- Department of Thoracic Surgery, Sun Yat-sen University Cancer Center, Guangzhou, China
- Guangdong Esophageal Cancer Institute, Guangzhou, China
| | - Jianye Yuan
- State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Sun Yat-sen University Cancer Center, Guangzhou, China
- Department of Thoracic Surgery, Sun Yat-sen University Cancer Center, Guangzhou, China
- Guangdong Esophageal Cancer Institute, Guangzhou, China
| | - Kexi Wang
- Department of Thoracic Surgery, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, China
| | - Jing Wen
- State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Sun Yat-sen University Cancer Center, Guangzhou, China
- Guangdong Esophageal Cancer Institute, Guangzhou, China
| | - Jianhua Fu
- State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Sun Yat-sen University Cancer Center, Guangzhou, China
- Department of Thoracic Surgery, Sun Yat-sen University Cancer Center, Guangzhou, China
- Guangdong Esophageal Cancer Institute, Guangzhou, China
| | - Qianwen Liu
- State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Sun Yat-sen University Cancer Center, Guangzhou, China
- Department of Thoracic Surgery, Sun Yat-sen University Cancer Center, Guangzhou, China
- Guangdong Esophageal Cancer Institute, Guangzhou, China
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Wu D, Zhang K, Zhang X. Primary mediastinal yolk sac tumor: A case report and literature review. Clin Case Rep 2023; 11:e7781. [PMID: 37564606 PMCID: PMC10410121 DOI: 10.1002/ccr3.7781] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2023] [Revised: 06/29/2023] [Accepted: 07/16/2023] [Indexed: 08/12/2023] Open
Abstract
Key Clinical Message There are limited published cases of primary mediastinal yolk sac tumor (PMYST), with no consensus on the best treatment alternative. By far, the surgery oriented comprehensive therapies are the main treatment methods. The surgical strategy should be individualized and aimed at radical resection, considering all the possibilities, including the use of cardiopulmonary bypass and prosthetic materials. Abstract A 15-year-old boy was diagnosed as PMYST. The tumor, with a size about 13 × 12 × 8 cm, was located in the right upper mediastinum, closely adhering to ascending aorta, superior vena cava, right atrium, and the right hilum. After 6 cycles chemotherapy of bleomycin, etoposide, and cisplatin (BEP), no significant change was found in the size of tumor. Subsequently, an extended tumor excision including partial resection of the right lung, the pericardium, the diaphragm and the right phrenic nerve, was performed successfully with cardiopulmonary bypass on standby. During 6 months of follow-up, there was no tumor recurrence. Meanwhile, in PubMed, we searched the English case reports and case series of PMYST during the past decade. A total of 73 articles were retrieved, in which 22 articles on the therapy and prognosis of PMYST were extracted and reviewed, included 16 case reports and 6 case series with a total of 52 patients. Due to the rarity of PMYST, it is difficult to provide a specific treatment regimen. The surgery-oriented comprehensive therapies are still the main treatment methods. The surgical strategy should be individualized and aim at radical resection, considering all the possibilities, including the use of cardiopulmonary bypass and prosthetic materials.
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Affiliation(s)
- Diqing Wu
- Department of Cardiac and Macrovascular SurgerySuzhou Hospital of Anhui Medical UniversitySuzhouChina
| | - Kun Zhang
- Department of OncologySuzhou Hospital of Anhui Medical UniversitySuzhouChina
| | - Xueqin Zhang
- Department of Cardiac and Macrovascular SurgerySuzhou Hospital of Anhui Medical UniversitySuzhouChina
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Wu P, Yang Y, Yu Z, Zhao L, Feng S. Clinical Features and Survival Outcomes in Children and Adolescents With Malignant Mediastinal Germ Cell Tumors Based on Surveillance, Epidemiology, and End Results Database Analysis. J Surg Res 2023; 288:362-371. [PMID: 37062232 DOI: 10.1016/j.jss.2023.03.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2022] [Revised: 02/28/2023] [Accepted: 03/16/2023] [Indexed: 04/18/2023]
Abstract
INTRODUCTION The purpose of this study was to perform a population-based investigation to assess the disease characteristics and prognosis of children and adolescents with malignant mediastinal germ cell tumors (MMGCT). METHODS Data on the demographics, treatment, and survival outcomes of children and adolescents with MMGCT from January 1, 2000 to December 31, 2018 were obtained. To compare survival curves, the log-rank test was employed. The generation of survival curves based on different parameters was done using Kaplan-Meier estimations. Cox proportional hazards regression was performed to determine the variables linked to disease-specific survival. RESULTS The selection criteria were met by 152 MMGCT patients, 130 of whom were male. Fifty three cases of mixed germ cell tumors (GCTs), 41 cases of malignant teratomas, 26 cases of yolk sac tumors, 14 cases of seminoma, 13 cases of choriocarcinomas, and five cases of embryonal carcinoma were reported. Overall survival at 3 and 5 y for all patients was 63.1% and 61.2%, respectively. Malignant teratoma, yolk sac tumors, and mixed GCTs in children and adolescents had comparable survival rates, while those with choriocarcinoma and embryonal carcinoma showed the worst prognosis. Embryonal carcinoma, malignant teratoma, mixed GCTs, and choriocarcinoma were found as risk factors by multivariate Cox proportional hazards analysis. In contrast, surgery and younger age were protective factors. However, chemotherapy alone showed no survival benefits. CONCLUSIONS Our population-based evidence showed that MMGCT had worse prognosis in older children and adolescents. Choriocarcinomas and embryonal carcinomas had the worst prognosis. Surgery can prolong survival time. Chemotherapy and radiotherapy were not associated with improved prognosis.
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Affiliation(s)
- Peng Wu
- Department of Pediatric Surgery, Northwest Women and Children's Hospital, Xi'an, China
| | - Yicheng Yang
- Department of Urology, Children's Hospital of Soochow University, Suzhou, Jiangsu, P.R. China
| | - Zhechen Yu
- Department of Urology, Children's Hospital of Soochow University, Suzhou, Jiangsu, P.R. China
| | - Lingling Zhao
- Department of Pathology, The First Affiliated Hospital of Zhejiang Chinese Medical University (Zhejiang Provincial Hospital of Traditional Chinese Medicine), Hangzhou, China
| | - Shaoguang Feng
- Department of Pediatric Surgery, Hangzhou Children's Hospital, Hangzhou, China.
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Aguiar Bujanda D, Pérez Cabrera D, Croissier Sánchez L. Extragonadal Germ Cell Tumors of the Mediastinum and Retroperitoneum: A Surveillance, Epidemiology, and End Results-based Study. Am J Clin Oncol 2022; 45:493-500. [PMID: 36394133 DOI: 10.1097/coc.0000000000000959] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
OBJECTIVES Extragonadal germ cell tumors (EGCT) are a rare entity, most of them being located in the mediastinum and retroperitoneum. Information on these tumors is scarce, requiring carrying out large population-based studies to better understand these diseases. We aimed to determine the clinical features and prognosis of patients with EGCT of the mediastinum and retroperitoneum. MATERIALS AND METHODS Demographic and clinicopathological features of patients diagnosed with EGCT of the mediastinum and retroperitoneum from 1975 to 2016 were retrieved from the Surveillance, Epidemiology, and End Results (SEER) database. RESULTS A total of 1674 patients were included, 1297 (77.5%) of mediastinal origin and 377 (22.5%) of retroperitoneum. Nonseminomatous tumors (56.3%) were slightly more frequent than seminomas (43.7%) with similar distribution between mediastinum and retroperitoneum. After a median follow-up of 137 months, the median overall survival was 263 months (95% CI, 220-296) whereas the median cause-specific survival (CSS) has still not been reached. The 10-year overall survival and CSS were 57.4% (95% CI, 55-59.7) and 63% (95% CI, 60.6-65.2) respectively. Multivariate analysis showed that older age, mediastinal location, nonseminomatous histology, and distant disease at diagnosis were independent prognostic factors correlated with a worse prognosis. Patients with mediastinal choriocarcinoma and embryonal carcinoma have the worst prognosis, both with a median CSS of only 12 months. CONCLUSIONS Despite a decreasing incidence observed in recent decades, EGCT continues to represent a challenge for oncologists. The prognosis of choriocarcinoma and embryonal carcinoma of the mediastinum remains poor and treatment strategies need to be improved urgently.
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Affiliation(s)
- David Aguiar Bujanda
- Department of Medical Oncology, Doctor Negrín University Hospital of Gran Canaria Las Palmas de Gran Canaria, Spain
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Chen Z, Wang X, Cao D, Qiu S, Li J, Chen B, Huang Y, Bao Y, Liu L, Wei Q. Clinical characteristics of testicular non-seminomatous germ cell tumor from West China: a 10-year experience. Chin Med J (Engl) 2022; 135:00029330-990000000-00074. [PMID: 35861303 PMCID: PMC9532027 DOI: 10.1097/cm9.0000000000002029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2021] [Indexed: 02/05/2023] Open
Affiliation(s)
- Zeyu Chen
- Department of Urology, Institute of Urology, West China Hospital, Sichuan University, Chengdu, Sichuan 610041, China
- West China School of Medicine, Sichuan University, Chengdu, Sichuan 610041, China
| | - Xingyuan Wang
- Department of Urology, Institute of Urology, West China Hospital, Sichuan University, Chengdu, Sichuan 610041, China
- West China School of Medicine, Sichuan University, Chengdu, Sichuan 610041, China
| | - Dehong Cao
- Department of Urology, Institute of Urology, West China Hospital, Sichuan University, Chengdu, Sichuan 610041, China
| | - Shi Qiu
- Department of Urology, Institute of Urology, West China Hospital, Sichuan University, Chengdu, Sichuan 610041, China
- Center of Biomedical Big Data, West China Hospital, Sichuan University, Chengdu, Sichuan 610041, China
| | - Jin Li
- Department of Urology, Institute of Urology, West China Hospital, Sichuan University, Chengdu, Sichuan 610041, China
- West China School of Medicine, Sichuan University, Chengdu, Sichuan 610041, China
| | - Bo Chen
- Department of Urology, Institute of Urology, West China Hospital, Sichuan University, Chengdu, Sichuan 610041, China
- West China School of Medicine, Sichuan University, Chengdu, Sichuan 610041, China
| | - Yin Huang
- West China School of Medicine, Sichuan University, Chengdu, Sichuan 610041, China
| | - Yige Bao
- Department of Urology, Institute of Urology, West China Hospital, Sichuan University, Chengdu, Sichuan 610041, China
| | - Liangren Liu
- Department of Urology, Institute of Urology, West China Hospital, Sichuan University, Chengdu, Sichuan 610041, China
| | - Qiang Wei
- Department of Urology, Institute of Urology, West China Hospital, Sichuan University, Chengdu, Sichuan 610041, China
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Kawakubo N, Okubo Y, Yotsukura M, Yoshida Y, Nakagawa K, Yonemori K, Watanabe H, Yatabe Y, Watanabe SI. Assessment of Resectability of Mediastinal Germ Cell Tumor Using Preoperative Computed Tomography. J Surg Res 2022; 272:61-68. [DOI: 10.1016/j.jss.2021.11.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2021] [Revised: 10/07/2021] [Accepted: 11/06/2021] [Indexed: 10/19/2022]
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How to classify, diagnose, treat and follow-up extragonadal germ cell tumors? A systematic review of available evidence. World J Urol 2022; 40:2863-2878. [PMID: 35554637 PMCID: PMC9712285 DOI: 10.1007/s00345-022-04009-z] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2021] [Accepted: 02/01/2022] [Indexed: 12/30/2022] Open
Abstract
PURPOSE To present the current evidence and the development of studies in recent years on the management of extragonadal germ cell tumors (EGCT). METHODS A systematic literature search was conducted in Medline and the Cochrane Library. Studies within the search period (January 2010 to February 2021) that addressed the classification, diagnosis, prognosis, treatment, and follow-up of extragonadal tumors were included. Risk of bias was assessed and relevant data were extracted in evidence tables. RESULTS The systematic search identified nine studies. Germ cell tumors (GCT) arise predominantly from within the testis, but about 5% of the tumors are primarily located extragonadal. EGCT are localized primarily mediastinal or retroperitoneal in the midline of the body. EGCT patients are classified according to the IGCCCG classification. Consecutively, all mediastinal non-seminomatous EGCT patients belong to the "poor prognosis" group. In contrast mediastinal seminoma and both retroperitoneal seminoma and non-seminoma patients seem to have a similar prognosis as patients with gonadal GCTs and metastasis at theses respective sites. The standard chemotherapy regimen for patients with a EGCT consists of 3-4 cycles (good vs intermediate prognosis) of bleomycin, etoposid, cisplatin (BEP); however, due to their very poor prognosis patients with non-seminomatous mediastinal GCT should receive a dose-intensified or high-dose chemotherapy approach upfront on an individual basis and should thus be referred to expert centers Ifosfamide may be exchanged for bleomycin in cases of additional pulmonary metastasis due to subsequently planned resections. In general patients with non-seminomatous EGCT, residual tumor resection (RTR) should be performed after chemotherapy. CONCLUSION In general, non-seminomatous EGCT have a poorer prognosis compared to testicular GCT, while seminomatous EGGCT seem to have a similar prognosis to patients with metastatic testicular seminoma. The current insights on EGCT are limited, since all data are mainly based on case series and studies with small patient numbers and non-comparative studies. In general, systemic treatment should be performed like in testicular metastatic GCTs but upfront dose intensification of chemotherapy should be considered for mediastinal non-seminoma patients. Thus, EGCT should be referred to interdisciplinary centers with utmost experience in the treatment of germ cell tumors.
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Yang X, Zhao K, Mei J, Wei S, Xia L, Pu Y, Liu L. Primary Mediastinal Nonseminomas: A Population-Based Surveillance, Epidemiology, and End Results Analysis. J Surg Res 2021; 267:25-36. [PMID: 34126390 DOI: 10.1016/j.jss.2021.04.022] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2020] [Revised: 03/26/2021] [Accepted: 04/10/2021] [Indexed: 02/05/2023]
Abstract
BACKGROUND This study aimed to determine the disease characteristics and prognosis of patients with primary mediastinal nonseminomas (PMNS) in a Surveillance, Epidemiology, and End Results (SEER) analysis. MATERIALS AND METHODS Demographic, treatment, and survival outcome data of cases with PMNS from 1975 to 2016 were retrieved. Cases with unknown variables mentioned in the analysis were excluded. Relative statistical methods were applied to analyze clinical characteristics and prognosis. RESULTS A total of 587 PMNS patients met the selection criteria, 526 of whom were men. The mean age of patients was 28 (1-85) y. A total of 511 PMNS patients had validated subtypes, including 172 mixed germ cell tumors, 117 yolk sac tumors, 111 malignant teratomas, 70 choriocarcinomas, and 41 embryonal carcinomas. Patients with yolk sac tumors had the highest 3-y cancer-specific survival (CSS) rate (66.9%), while those with choriocarcinoma and embryonal carcinoma showed the worst prognosis. Surgery + chemotherapy (46.2%) was the most common and effective treatment for each subtype of PMNS. Multivariate Cox proportional hazards analysis identified embryonal carcinoma, malignant teratoma, choriocarcinoma, tumor size >15 cm, nodal metastasis, and distant stage as risk factors. In contrast, surgery-based care and younger age were protective factors. Propensity score matching analysis revealed significant improvement in the 5-y CSS rate from 35.8% to 60.3% with surgery (P < 0.001). However, radiotherapy (P = 0.436) and chemotherapy (P = 0.978) showed no survival benefits. CONCLUSIONS 10 percent of the PMNS patients were female. Choriocarcinomas and embryonal carcinomas had the worst prognosis. Surgery was demonstrated to be the only way to prolong survival time. Chemotherapy and radiotherapy had minimal effects on prognosis.
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Affiliation(s)
- Xudong Yang
- Department of Thoracic Surgery, West China Hospital, Sichuan University, Chengdu, Sichuan, China; Western China Collaborative Innovation Center for Early Diagnosis and Multidisciplinary Therapy of Lung Cancer, Sichuan University, Chengdu, China
| | - Kejia Zhao
- Department of Thoracic Surgery, West China Hospital, Sichuan University, Chengdu, Sichuan, China; Western China Collaborative Innovation Center for Early Diagnosis and Multidisciplinary Therapy of Lung Cancer, Sichuan University, Chengdu, China
| | - Jiandong Mei
- Department of Thoracic Surgery, West China Hospital, Sichuan University, Chengdu, Sichuan, China; Western China Collaborative Innovation Center for Early Diagnosis and Multidisciplinary Therapy of Lung Cancer, Sichuan University, Chengdu, China
| | - Shiyou Wei
- Department of Thoracic Surgery, West China Hospital, Sichuan University, Chengdu, Sichuan, China; Western China Collaborative Innovation Center for Early Diagnosis and Multidisciplinary Therapy of Lung Cancer, Sichuan University, Chengdu, China
| | - Liang Xia
- Department of Thoracic Surgery, West China Hospital, Sichuan University, Chengdu, Sichuan, China; Western China Collaborative Innovation Center for Early Diagnosis and Multidisciplinary Therapy of Lung Cancer, Sichuan University, Chengdu, China
| | - Yi Pu
- Department of Thoracic Surgery, West China Hospital, Sichuan University, Chengdu, Sichuan, China; Western China Collaborative Innovation Center for Early Diagnosis and Multidisciplinary Therapy of Lung Cancer, Sichuan University, Chengdu, China
| | - Lunxu Liu
- Department of Thoracic Surgery, West China Hospital, Sichuan University, Chengdu, Sichuan, China; Western China Collaborative Innovation Center for Early Diagnosis and Multidisciplinary Therapy of Lung Cancer, Sichuan University, Chengdu, China.
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El-Zaatari ZM, Ro JY. Mediastinal Germ Cell Tumors: A Review and Update on Pathologic, Clinical, and Molecular Features. Adv Anat Pathol 2021; 28:335-350. [PMID: 34029275 DOI: 10.1097/pap.0000000000000304] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Mediastinal germ cell tumors (MGCTs) are the most common extragonadal germ cell tumors (GCTs) and most often arise in the anterior mediastinum with a male predilection. MGCTs also have a predilection for patients with Klinefelter syndrome and possibly other genetic conditions. MGCTs, as GCTs at other extragonadal sites, are thought to arise from germ cells improperly retained during migration along the midline during embryogenesis. Similar to their counterparts in the testes, MGCTs are classified into seminomatous and nonseminomatous GCTs. Seminomatous MGCT represents pure seminoma, whereas nonseminomatous MGCTs encompass pure yolk sac tumors, embryonal carcinoma, choriocarcinoma, mature or immature teratoma, and mixed GCTs with any combination of GCT types, including seminoma. Somatic-type or hematologic malignancies can also occur in association with a primary MGCT. MGCTs share molecular findings with GCTs at other sites, most commonly the presence of chromosome 12p gains and isochromosome i(12p). Treatment includes neoadjuvant chemotherapy followed by surgical resection of residual tumor, with the exception of benign teratomas, which require only surgical resection without chemotherapy. In this review, we highlight and provide an update on pathologic, clinical, and molecular features of MGCTs. Immunohistochemical profiles of each tumor type, as well as differential diagnostic considerations, are discussed.
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Affiliation(s)
- Ziad M El-Zaatari
- Department of Pathology and Genomic Medicine, Houston Methodist Hospital, Houston, TX
| | - Jae Y Ro
- Department of Pathology and Genomic Medicine, Houston Methodist Hospital, Houston, TX
- Weill Medical College of Cornell University (WCMC), New York, NY
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Collins K, Alkashash AM, Hwang M, Kaimakliotis HZ, Cheng L, Idrees MT. Somatic-Type Yolk Sac Tumor Arising as a Predominant Component of Bladder Urothelial Carcinoma. Int J Surg Pathol 2021; 30:207-213. [PMID: 34255554 DOI: 10.1177/10668969211030688] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Germ cell differentiation has been described in association with somatic tumors arising from several organ systems; rare cases arising from urothelium have been reported. Here we present a 62-year-old male with a remote history of lung cancer, a left adrenal gland mass, and a 5.6 cm left bladder wall mass; cystoscopy demonstrated a large papillary mass on the left anterior bladder wall. A transurethral resection specimen was sent for review in consultation and showed extensive papillary structures with thin fibrovascular cores lined by neoplastic cells with clear cytoplasm. These neoplastic cells were diffusely positive for pancytokeratin, CDX2 (caudal-type homebox 2), SALL4 (sal-like transcription factor 4), glypican-3, AFP (alpha-fetoprotein), while negative for PAX-8 (paired box gene 8), NKX3.1 (NK3 homeobox 1), PSA (prostate specific antigen), TTF-1 (thyroid transcription factor 1), Napsin A, inhibin, and OCT4 (octamer-binding transcription factor 4). Conventional urothelial conventional carcinoma and focal squamous differentiation were also identified as minor components. Urothelial carcinoma was focally positive for GATA3 (GATA-binding protein 3) and p63; SALL4 and glypican-3 were negative. Overall findings supported a yolk sac tumor with a smaller component of squamous cell carcinoma (<1%). Subsequent cystectomy showed similar morphologic features and immunoprofile in addition to foci of urothelial carcinoma and urothelial carcinoma in situ. No chromosome 12p abnormalities were identified by fluorescent in-situ hybridization study. A diagnosis of yolk sac tumor derived from urothelial carcinoma was made. Yolk sac tumor should be considered in the differential diagnosis of a high-grade urothelial carcinoma, particularly when glandular or other unusual architectural patterns are present. A somatic origin with underlying genomic instability similar to what has been described in the uterus and ovaries is suggested.
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Affiliation(s)
- Katrina Collins
- 12250Department of Pathology, Indiana University School of Medicine, Indianapolis, IN, USA
| | - Ahmad M Alkashash
- 12250Department of Pathology, Indiana University School of Medicine, Indianapolis, IN, USA
| | - Michael Hwang
- 12250Department of Pathology, Indiana University School of Medicine, Indianapolis, IN, USA
| | - Hristos Z Kaimakliotis
- 12250Department of Urology, Indiana University School of Medicine, Indianapolis, IN, USA
| | - Liang Cheng
- 12250Department of Pathology, Indiana University School of Medicine, Indianapolis, IN, USA
| | - Muhammad T Idrees
- 12250Department of Pathology, Indiana University School of Medicine, Indianapolis, IN, USA
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Biswas B, Dabkara D, Sengupta M, Ganguly S, Ghosh J, Arunsingh S M, Sen S. Multimodality treatment outcome in patients with primary malignant mediastinal germ cell tumor in adults. Cancer Rep (Hoboken) 2021; 4:e1306. [PMID: 33029924 PMCID: PMC7941572 DOI: 10.1002/cnr2.1306] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2020] [Revised: 08/29/2020] [Accepted: 09/23/2020] [Indexed: 12/03/2022] Open
Abstract
BACKGROUND Malignant mediastinal germ cell tumor (MGCT) is rare and has poor outcomes even after multimodality treatment. Data from resource-poor countries are scarce in the literature. AIMS To evaluate the clinicopathologic features and treatment outcome of primary malignant MGCT at our center. METHODS AND RESULTS Single institutional data review of patients aged ≥18 years, treated with a diagnosis of malignant MGCT between Nov'2013 and Nov'2019. Risk stratification was done as per International Germ Cell Cancer Collaborative Group (IGCCCG) classification. Patients were treated with platinum based chemotherapy and surgical resection for the residual disease was performed in non-seminomatous histology.28 patients had MGCT with a median age of 25 years (range:18-36) and all were male. Seven patients had superior vena cava obstruction (SVCO) at diagnosis and pre-treatment histological diagnosis was available in 23 (82%) patients. Seven (25%) patients had seminoma histology, all were of good risk as per IGCCCG risk criteria, whereas others had non-seminoma histology with poor-risk group. Seven patients with seminoma histology achieved a complete response after initial treatment. Six patients with non-seminoma histology underwent complete resection of residual disease post-chemotherapy and five revealed residual viable tumors. After a median follow-up of 10.8 months (range:2.9-75), 3-year progression-free survival (PFS) and overall survival (OS) estimate was 61.2% and 94.7% in the whole cohort, respectively and 3-year PFS and OS estimate was 100% in patients with seminoma histology. CONCLUSIONS This is the largest data set of MGCT patients' outcomes reported from India with multi-modality treatment. All patients were male and one-fourth had SVCO at presentation. Seminoma histology patients had a 100% outcome after initial platinum based chemotherapy. But, those with non-seminoma histology had a poor outcome even with chemotherapy and surgery.
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Affiliation(s)
- Bivas Biswas
- Department of Medical OncologyTata Medical CenterKolkataIndia
| | - Deepak Dabkara
- Department of Medical OncologyTata Medical CenterKolkataIndia
| | | | - Sandip Ganguly
- Department of Medical OncologyTata Medical CenterKolkataIndia
| | - Joydeep Ghosh
- Department of Medical OncologyTata Medical CenterKolkataIndia
| | | | - Saugata Sen
- Department of RadiodiagnosisTata Medical CenterKolkataIndia
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Koizumi T, Kanda S, Nihonmatu R, Gomi D, Sekiguchi N, Noguchi T, Fukushima T, Kobayashi T, Yamamoto H, Takeda T. Primary mediastinal germ cell tumors - A retrospective analysis of >30 years of experience in a single institution. Thorac Cancer 2021; 12:807-813. [PMID: 33502089 PMCID: PMC7952792 DOI: 10.1111/1759-7714.13859] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2020] [Revised: 01/09/2021] [Accepted: 01/10/2021] [Indexed: 12/01/2022] Open
Abstract
Background This study was performed to clarify the treatment outcome of patients with primary mediastinal germ cell tumors (PMGCTs), focusing on the clinical manifestations and management during definitive therapy and long‐term follow‐up. Methods In this study, we retrospectively reviewed the medical records of patients with PMGCTs treated at Shinshu University School of Medicine, and examined the clinical profiles and treatment outcomes of 22 patients (mean age of 29 years) with primary mediastinal GCTs treated at our hospital between 1983 and 2019. Results Five patients were diagnosed with pure seminoma and 17 had nonseminomatous GCT. A total of 21 patients were treated with cisplatin‐based chemotherapy and 15 patients (68.2%) underwent thoracic surgery after chemotherapy. Although all cases of nonseminomatous GCT were negative for tumor markers after cisplatin‐based chemotherapy, two cases showed variable GCT cells and two had somatic components (angiosarcoma and rhabdomyosarcoma) in resected specimens. Three relapsed soon after surgery. Growing teratoma syndrome developed during chemotherapy in four cases. Urgent thoracic surgery was performed in three patients, but one case was inoperable. The calculated 10‐year overall survival rates were 100% in mediastinal seminoma and 64.7% in NSGCT. During follow‐up, second non‐GCT malignancies developed in three patients (colon cancer, 190 months; thyroid cancer, 260 months; non‐small cell lung cancer, 250 months after the initial chemotherapy) and one patient with primary mediastinal seminoma was associated with multiple type I endocrine tumors. Conclusions Our experiences demonstrated that long‐term survival and/or cure can be achieved with adequate chemotherapy followed by local surgical treatment even in patients with mediastinal GCTs. However, the clinical manifestations and biological behaviors during and/or after chemotherapy were complex and varied. In addition, the development of secondary malignancies should be taken into consideration for long‐term follow‐up. Clinicians should be aware of the various clinical features and secondary malignancies in primary mediastinal GCTs.
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Affiliation(s)
- Tomonobu Koizumi
- Department of Comprehensive Cancer Therapy, Shinshu University School of Medicine, Matsumoto, Japan
| | - Shintaro Kanda
- Department of Comprehensive Cancer Therapy, Shinshu University School of Medicine, Matsumoto, Japan
| | - Ryo Nihonmatu
- Department of Comprehensive Cancer Therapy, Shinshu University School of Medicine, Matsumoto, Japan
| | - Daisuke Gomi
- Department of Comprehensive Cancer Therapy, Shinshu University School of Medicine, Matsumoto, Japan
| | - Nodoka Sekiguchi
- Department of Comprehensive Cancer Therapy, Shinshu University School of Medicine, Matsumoto, Japan
| | - Takuro Noguchi
- Department of Comprehensive Cancer Therapy, Shinshu University School of Medicine, Matsumoto, Japan
| | - Toshirou Fukushima
- Department of Comprehensive Cancer Therapy, Shinshu University School of Medicine, Matsumoto, Japan
| | - Takashi Kobayashi
- Department of Comprehensive Cancer Therapy, Shinshu University School of Medicine, Matsumoto, Japan
| | - Hiroshi Yamamoto
- First Department of Internal Medicine, Shinshu University School of Medicine, Matsumoto, Japan
| | - Tetsu Takeda
- Department of Thoracic Surgery, Shinshu University School of Medicine, Matsumoto, Japan
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Géczi L, Budai B, Polk N, Fazekas F, Bodrogi I, Biró K. Neutrophil-to-lymphocyte ratio in primary mediastinal germ cell tumors: A retrospective analysis of >20 years single institution experience. Curr Probl Cancer 2020; 44:100537. [PMID: 31980147 DOI: 10.1016/j.currproblcancer.2020.100537] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2019] [Accepted: 12/12/2019] [Indexed: 01/19/2023]
Abstract
OBJECTIVES To obtain information on outcome stratified by histology, extent and primary treatment patients' data with primary malignant mediastinal germ cell tumors treated between 1998 and 2018 were retrospectively analyzed. METHODS The primary treatment for localized malignant mediastinal germ cell tumors was neoadjuvant bleomycin + etoposid + cisplatin (BEP) ± surgery (n = 22); or surgery ± adjuvant BEP (n = 16). For disseminated disease (n = 21) first line BEP ± second line chemotherapy were administered. For nonseminomas (NS) the NLR at start of BEP was analyzed in relation to disease-free survival (DFS), progression-free survival (PFS), and overall survival (OS). RESULTS After neoadjuvant treatment the 5-year DFS was 100% for seminomas (S), and 63.4% for NS. The 5-year OS was 100% for S, and 76.9% for NS. The 5-year DFS and OS after surgery ± BEP for S was 72.9% and 100%, for NS was 75% and 87.5%, respectively. The 5-year PFS and OS of metastatic patients for S was 60% and 80%, while the median PFS and OS of NS were 5.7 and 11.1 months, respectively. Objective response (P = 0.006) and low NLR (P = 0.043) were independent prognostic markers of longer OS. CONCLUSIONS We confirmed the good outcome of BEP-treated S, while NS had poorer prognosis. Previously published prognostic models for NS were validated. Based on NLR and response a new prognostic model was developed.
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Affiliation(s)
- Lajos Géczi
- National Institute of Oncology, Budapest, Hungary
| | - Barna Budai
- National Institute of Oncology, Budapest, Hungary.
| | - Nándor Polk
- National Institute of Oncology, Budapest, Hungary
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Honecker F, Aparicio J, Berney D, Beyer J, Bokemeyer C, Cathomas R, Clarke N, Cohn-Cedermark G, Daugaard G, Dieckmann KP, Fizazi K, Fosså S, Germa-Lluch JR, Giannatempo P, Gietema JA, Gillessen S, Haugnes HS, Heidenreich A, Hemminki K, Huddart R, Jewett MAS, Joly F, Lauritsen J, Lorch A, Necchi A, Nicolai N, Oing C, Oldenburg J, Ondruš D, Papachristofilou A, Powles T, Sohaib A, Ståhl O, Tandstad T, Toner G, Horwich A. ESMO Consensus Conference on testicular germ cell cancer: diagnosis, treatment and follow-up. Ann Oncol 2019; 29:1658-1686. [PMID: 30113631 DOI: 10.1093/annonc/mdy217] [Citation(s) in RCA: 195] [Impact Index Per Article: 39.0] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
The European Society for Medical Oncology (ESMO) consensus conference on testicular cancer was held on 3-5 November 2016 in Paris, France. The conference included a multidisciplinary panel of 36 leading experts in the diagnosis and treatment of testicular cancer (34 panel members attended the conference; an additional two panel members [CB and K-PD] participated in all preparatory work and subsequent manuscript development). The aim of the conference was to develop detailed recommendations on topics relating to testicular cancer that are not covered in detail in the current ESMO Clinical Practice Guidelines (CPGs) and where the available level of evidence is insufficient. The main topics identified for discussion related to: (1) diagnostic work-up and patient assessment; (2) stage I disease; (3) stage II-III disease; (4) post-chemotherapy surgery, salvage chemotherapy, salvage and desperation surgery and special topics; and (5) survivorship and follow-up schemes. The experts addressed questions relating to one of the five topics within five working groups. Relevant scientific literature was reviewed in advance. Recommendations were developed by the working groups and then presented to the entire panel. A consensus vote was obtained following whole-panel discussions, and the consensus recommendations were then further developed in post-meeting discussions in written form. This manuscript presents the results of the expert panel discussions, including the consensus recommendations and a summary of evidence supporting each recommendation. All participants approved the final manuscript.
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Affiliation(s)
- F Honecker
- Tumor and Breast Center ZeTuP, St. Gallen, Switzerland; Department of Oncology, Hematology and Bone Marrow Transplantation with Section Pneumology, Hubertus Wald Tumorzentrum, University Medical Center, Hamburg, Germany.
| | - J Aparicio
- Department of Medical Oncology, Hospital Universitari i Politècnic la Fe, Valencia, Spain
| | - D Berney
- Department of Molecular Oncology, Barts Cancer Institute, Queen Mary University of London, London, UK
| | - J Beyer
- Department of Medical Oncology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - C Bokemeyer
- Department of Oncology, Hematology and Bone Marrow Transplantation with Section Pneumology, Hubertus Wald Tumorzentrum, University Medical Center, Hamburg, Germany
| | - R Cathomas
- Department of Oncology and Hematology, Kantonsspital Graubünden, Chur, Switzerland
| | - N Clarke
- Department of Surgery, The Christie NHS Foundation Trust, Manchester, UK
| | - G Cohn-Cedermark
- Department of Oncology-Pathology, Karolinska Institute and Karolinska University Hospital, Stockholm, Sweden
| | - G Daugaard
- Department of Oncology, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
| | - K-P Dieckmann
- Department of Urology, Asklepios Klinik Altona, Hamburg, Germany
| | - K Fizazi
- Department of Cancer Medicine, Gustave Roussy, University of Paris Sud, Villejuif, France
| | - S Fosså
- Department of Oncology, Oslo University Hospital Radiumhospitalet, Oslo, Norway
| | - J R Germa-Lluch
- Department of Medical Oncology, Catalan Institute of Oncology (ICO), Barcelona University, Barcelona, Spain
| | - P Giannatempo
- Department of Medical Oncology, Fondazione IRCCS Istituto dei Tumori, Milan, Italy
| | - J A Gietema
- Department of Medical Oncology, University Medical Center Groningen, Groningen, The Netherlands
| | - S Gillessen
- Department of Oncology and Hematology, Kantonsspital St. Gallen, St. Gallen; University of Bern, Bern, Switzerland
| | - H S Haugnes
- Department of Oncology, University Hospital of North Norway, Tromsø, Norway; Institute of Clinical Medicine, UIT - The Arctic University, Tromsø, Norway
| | - A Heidenreich
- Department of Urology, Uro-Oncology, Robot-assisted and Specialised Urologic Surgery, University of Cologne, Cologne, Germany
| | - K Hemminki
- Department of Molecular Genetic Epidemiology, German Cancer Research Center, Heidelberg, Germany
| | - R Huddart
- Department of Radiotherapy and Imaging, The Institute of Cancer Research, Royal Marsden Hospital, Sutton, UK
| | - M A S Jewett
- Departments of Surgery (Urology) and Surgical Oncology, Princess Margaret Cancer Center, University Health Network, University of Toronto, Toronto, Canada
| | - F Joly
- Department of Urology-Gynaecology, Centre Francois Baclesse, Caen, France
| | - J Lauritsen
- Department of Oncology, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
| | - A Lorch
- Department of Urology, Genitourinary Medical Oncology, Heinrich-Heine University Hospital Düsseldorf, Düsseldorf, Germany
| | - A Necchi
- Department of Medical Oncology, Fondazione IRCCS Istituto dei Tumori, Milan, Italy
| | - N Nicolai
- Department of Surgery, Urology and Testis Surgery Unit, Fondazione IRCCS Istituto dei Tumori, Milan, Italy
| | - C Oing
- Department of Oncology, Hematology and Bone Marrow Transplantation with Section Pneumology, Hubertus Wald Tumorzentrum, University Medical Center, Hamburg, Germany
| | - J Oldenburg
- Department of Oncology, Akershus University Hospital, Lørenskog, Norway
| | - D Ondruš
- 1st Department of Oncology, St. Elisabeth Cancer Institute, Comenius University Faculty of Medicine, Bratislava, Slovak Republic
| | - A Papachristofilou
- Department of Radiation Oncology, University Hospital Basel, Basel, Switzerland
| | - T Powles
- Department of Medical Oncology, Barts Cancer Institute, Queen Mary University of London, London, UK
| | - A Sohaib
- Department of Radiology, Royal Marsden Hospital, Sutton, UK
| | - O Ståhl
- Department of Oncology, Skane University Hospital, Lund University, Lund, Sweden
| | - T Tandstad
- The Cancer Clinic, St. Olavs Hospital, Trondheim, Norway
| | - G Toner
- Department of Medical Oncology, Peter MacCallum Cancer Centre and University of Melbourne, Melbourne, Australia
| | - A Horwich
- The Institute of Cancer Research, Royal Marsden Hospital, Sutton, UK
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Rosti G, Secondino S, Necchi A, Fornarini G, Pedrazzoli P. Primary mediastinal germ cell tumors. Semin Oncol 2019; 46:107-111. [DOI: 10.1053/j.seminoncol.2019.04.001] [Citation(s) in RCA: 26] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/22/2018] [Revised: 04/05/2019] [Accepted: 04/11/2019] [Indexed: 11/11/2022]
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Grabski DF, Pappo AS, Krasin MJ, Davidoff AM, Rao BN, Fernandez-Pineda I. Long-term outcomes of pediatric and adolescent mediastinal germ cell tumors: a single pediatric oncology institutional experience. Pediatr Surg Int 2017; 33:235-244. [PMID: 27838767 DOI: 10.1007/s00383-016-4020-0] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 10/25/2016] [Indexed: 11/29/2022]
Abstract
PURPOSE To evaluate the epidemiologic, demographic, and clinical characteristics, as well as prognostic factors and long-term outcomes of mediastinal germ cell tumors (MGCT) in children. PATIENTS AND METHODS A retrospective study of pediatric patients diagnosed with a primary MGCT between January 1963 and August of 2014 was performed. RESULTS Twenty-five patients were identified. Six children with teratomas were treated with resection alone (median age 7.8 years, range newborn to 15 years) and were cured without recurrence or progression. Nineteen children were treated for a malignant MGCT (median age 11.7 years, range 7 months-18 years); 5 year overall survival (OS) was 0.39 ± 0.12. For malignant non-seminomatous mediastinal germ cell tumors, platinum-based chemotherapy regimen (OS 0.56 vs 0.14, p = 0.03), complete surgical resection with negative margins (OS 0.73 vs 0.11, p = 0.03); and localized disease (OS 0.76 vs 0.0, p = 0.004) demonstrated a survival advantage. CONCLUSIONS Initial surgical resection is appropriate for teratomas. Localized disease, complete resection, and platinum-based chemotherapy are associated with improved survival in malignant non-seminomatous mediastinal germ cell tumors. Neoadjuvant, platinum-based three drug regimens followed by delayed surgical resection is the appropriate treatment modality for malignant mediastinal germ cell tumors.
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Affiliation(s)
- D F Grabski
- Department of Surgery, St. Jude Children's Research Hospital, Memphis, TN, USA
| | - A S Pappo
- Department of Oncology, St. Jude Children's Research Hospital, Memphis, TN, USA
| | - M J Krasin
- Department of Radiation Oncology, St. Jude Children's Research Hospital, Memphis, TN, USA
| | - A M Davidoff
- Department of Surgery, St. Jude Children's Research Hospital, Memphis, TN, USA
| | - B N Rao
- Department of Surgery, St. Jude Children's Research Hospital, Memphis, TN, USA
| | - I Fernandez-Pineda
- Department of Surgery, St. Jude Children's Research Hospital, Memphis, TN, USA.
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Feldman DR, Hu J, Dorff TB, Lim K, Patil S, Woo KM, Carousso M, Hughes A, Sheinfeld J, Bains M, Daneshmand S, Ketchens C, Bajorin DF, Bosl GJ, Quinn DI, Motzer RJ. Paclitaxel, Ifosfamide, and Cisplatin Efficacy for First-Line Treatment of Patients With Intermediate- or Poor-Risk Germ Cell Tumors. J Clin Oncol 2016; 34:2478-83. [PMID: 27185842 DOI: 10.1200/jco.2016.66.7899] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
PURPOSE Paclitaxel, ifosfamide, and cisplatin (TIP) achieved complete responses (CRs) in two thirds of patients with advanced germ cell tumors (GCTs) who relapsed after first-line chemotherapy with cisplatin and etoposide with or without bleomycin. We tested the efficacy of first-line TIP in patients with intermediate- or poor-risk disease. PATIENTS AND METHODS In this prospective, multicenter, single-arm phase II trial, previously untreated patients with International Germ Cell Cancer Collaborative Group poor-risk or modified intermediate-risk GCTs received four cycles of TIP (paclitaxel 240 mg/m(2) over 2 days, ifosfamide 6 g/m(2) over 5 days with mesna support, and cisplatin 100 mg/m(2) over 5 days) once every 3 weeks with granulocyte colony-stimulating factor support. The primary end point was the CR rate. RESULTS Of the first 41 evaluable patients, 28 (68%) achieved a CR, meeting the primary efficacy end point. After additional accrual on an extension phase, total enrollment was 60 patients, including 40 (67%) with poor risk and 20 (33%) with intermediate risk. Thirty-eight (68%) of 56 evaluable patients achieved a CR and seven (13%) achieved partial responses with negative markers (PR-negative) for a favorable response rate of 80%. Five of seven achieving PR-negative status had seminoma and therefore did not undergo postchemotherapy resection of residual masses. Estimated 3-year progression-free survival and overall survival rates were 72% (poor risk, 63%; intermediate risk, 90%) and 91% (poor risk, 87%; intermediate risk, 100%), respectively. Grade 3 to 4 toxicities consisted primarily of reversible hematologic or electrolyte abnormalities, including neutropenic fever in 18%. CONCLUSION TIP demonstrated efficacy as first-line therapy for intermediate- and poor-risk GCTs with an acceptable safety profile. Given higher rates of favorable response, progression-free survival, and overall survival compared with prior first-line studies, TIP warrants further study in this population.
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Affiliation(s)
- Darren R Feldman
- Darren R. Feldman, Kristina Lim, Sujata Patil, Kaitlin M. Woo, Maryann Carousso, Amanda Hughes, Joel Sheinfeld, Manjit Bains, Dean F. Bajorin, George J. Bosl, and Robert J. Motzer, Memorial Sloan Kettering Cancer Center; Darren R. Feldman, Dean F. Bajorin, George J. Bosl, and Robert J. Motzer, Weill Medical College of Cornell University, New York, NY; and James Hu, Tanya B. Dorff, Siamak Daneshmand, Charlene Ketchens, and David I. Quinn, University of Southern California Norris Comprehensive Cancer Center, Los Angeles, CA.
| | - James Hu
- Darren R. Feldman, Kristina Lim, Sujata Patil, Kaitlin M. Woo, Maryann Carousso, Amanda Hughes, Joel Sheinfeld, Manjit Bains, Dean F. Bajorin, George J. Bosl, and Robert J. Motzer, Memorial Sloan Kettering Cancer Center; Darren R. Feldman, Dean F. Bajorin, George J. Bosl, and Robert J. Motzer, Weill Medical College of Cornell University, New York, NY; and James Hu, Tanya B. Dorff, Siamak Daneshmand, Charlene Ketchens, and David I. Quinn, University of Southern California Norris Comprehensive Cancer Center, Los Angeles, CA
| | - Tanya B Dorff
- Darren R. Feldman, Kristina Lim, Sujata Patil, Kaitlin M. Woo, Maryann Carousso, Amanda Hughes, Joel Sheinfeld, Manjit Bains, Dean F. Bajorin, George J. Bosl, and Robert J. Motzer, Memorial Sloan Kettering Cancer Center; Darren R. Feldman, Dean F. Bajorin, George J. Bosl, and Robert J. Motzer, Weill Medical College of Cornell University, New York, NY; and James Hu, Tanya B. Dorff, Siamak Daneshmand, Charlene Ketchens, and David I. Quinn, University of Southern California Norris Comprehensive Cancer Center, Los Angeles, CA
| | - Kristina Lim
- Darren R. Feldman, Kristina Lim, Sujata Patil, Kaitlin M. Woo, Maryann Carousso, Amanda Hughes, Joel Sheinfeld, Manjit Bains, Dean F. Bajorin, George J. Bosl, and Robert J. Motzer, Memorial Sloan Kettering Cancer Center; Darren R. Feldman, Dean F. Bajorin, George J. Bosl, and Robert J. Motzer, Weill Medical College of Cornell University, New York, NY; and James Hu, Tanya B. Dorff, Siamak Daneshmand, Charlene Ketchens, and David I. Quinn, University of Southern California Norris Comprehensive Cancer Center, Los Angeles, CA
| | - Sujata Patil
- Darren R. Feldman, Kristina Lim, Sujata Patil, Kaitlin M. Woo, Maryann Carousso, Amanda Hughes, Joel Sheinfeld, Manjit Bains, Dean F. Bajorin, George J. Bosl, and Robert J. Motzer, Memorial Sloan Kettering Cancer Center; Darren R. Feldman, Dean F. Bajorin, George J. Bosl, and Robert J. Motzer, Weill Medical College of Cornell University, New York, NY; and James Hu, Tanya B. Dorff, Siamak Daneshmand, Charlene Ketchens, and David I. Quinn, University of Southern California Norris Comprehensive Cancer Center, Los Angeles, CA
| | - Kaitlin M Woo
- Darren R. Feldman, Kristina Lim, Sujata Patil, Kaitlin M. Woo, Maryann Carousso, Amanda Hughes, Joel Sheinfeld, Manjit Bains, Dean F. Bajorin, George J. Bosl, and Robert J. Motzer, Memorial Sloan Kettering Cancer Center; Darren R. Feldman, Dean F. Bajorin, George J. Bosl, and Robert J. Motzer, Weill Medical College of Cornell University, New York, NY; and James Hu, Tanya B. Dorff, Siamak Daneshmand, Charlene Ketchens, and David I. Quinn, University of Southern California Norris Comprehensive Cancer Center, Los Angeles, CA
| | - Maryann Carousso
- Darren R. Feldman, Kristina Lim, Sujata Patil, Kaitlin M. Woo, Maryann Carousso, Amanda Hughes, Joel Sheinfeld, Manjit Bains, Dean F. Bajorin, George J. Bosl, and Robert J. Motzer, Memorial Sloan Kettering Cancer Center; Darren R. Feldman, Dean F. Bajorin, George J. Bosl, and Robert J. Motzer, Weill Medical College of Cornell University, New York, NY; and James Hu, Tanya B. Dorff, Siamak Daneshmand, Charlene Ketchens, and David I. Quinn, University of Southern California Norris Comprehensive Cancer Center, Los Angeles, CA
| | - Amanda Hughes
- Darren R. Feldman, Kristina Lim, Sujata Patil, Kaitlin M. Woo, Maryann Carousso, Amanda Hughes, Joel Sheinfeld, Manjit Bains, Dean F. Bajorin, George J. Bosl, and Robert J. Motzer, Memorial Sloan Kettering Cancer Center; Darren R. Feldman, Dean F. Bajorin, George J. Bosl, and Robert J. Motzer, Weill Medical College of Cornell University, New York, NY; and James Hu, Tanya B. Dorff, Siamak Daneshmand, Charlene Ketchens, and David I. Quinn, University of Southern California Norris Comprehensive Cancer Center, Los Angeles, CA
| | - Joel Sheinfeld
- Darren R. Feldman, Kristina Lim, Sujata Patil, Kaitlin M. Woo, Maryann Carousso, Amanda Hughes, Joel Sheinfeld, Manjit Bains, Dean F. Bajorin, George J. Bosl, and Robert J. Motzer, Memorial Sloan Kettering Cancer Center; Darren R. Feldman, Dean F. Bajorin, George J. Bosl, and Robert J. Motzer, Weill Medical College of Cornell University, New York, NY; and James Hu, Tanya B. Dorff, Siamak Daneshmand, Charlene Ketchens, and David I. Quinn, University of Southern California Norris Comprehensive Cancer Center, Los Angeles, CA
| | - Manjit Bains
- Darren R. Feldman, Kristina Lim, Sujata Patil, Kaitlin M. Woo, Maryann Carousso, Amanda Hughes, Joel Sheinfeld, Manjit Bains, Dean F. Bajorin, George J. Bosl, and Robert J. Motzer, Memorial Sloan Kettering Cancer Center; Darren R. Feldman, Dean F. Bajorin, George J. Bosl, and Robert J. Motzer, Weill Medical College of Cornell University, New York, NY; and James Hu, Tanya B. Dorff, Siamak Daneshmand, Charlene Ketchens, and David I. Quinn, University of Southern California Norris Comprehensive Cancer Center, Los Angeles, CA
| | - Siamak Daneshmand
- Darren R. Feldman, Kristina Lim, Sujata Patil, Kaitlin M. Woo, Maryann Carousso, Amanda Hughes, Joel Sheinfeld, Manjit Bains, Dean F. Bajorin, George J. Bosl, and Robert J. Motzer, Memorial Sloan Kettering Cancer Center; Darren R. Feldman, Dean F. Bajorin, George J. Bosl, and Robert J. Motzer, Weill Medical College of Cornell University, New York, NY; and James Hu, Tanya B. Dorff, Siamak Daneshmand, Charlene Ketchens, and David I. Quinn, University of Southern California Norris Comprehensive Cancer Center, Los Angeles, CA
| | - Charlene Ketchens
- Darren R. Feldman, Kristina Lim, Sujata Patil, Kaitlin M. Woo, Maryann Carousso, Amanda Hughes, Joel Sheinfeld, Manjit Bains, Dean F. Bajorin, George J. Bosl, and Robert J. Motzer, Memorial Sloan Kettering Cancer Center; Darren R. Feldman, Dean F. Bajorin, George J. Bosl, and Robert J. Motzer, Weill Medical College of Cornell University, New York, NY; and James Hu, Tanya B. Dorff, Siamak Daneshmand, Charlene Ketchens, and David I. Quinn, University of Southern California Norris Comprehensive Cancer Center, Los Angeles, CA
| | - Dean F Bajorin
- Darren R. Feldman, Kristina Lim, Sujata Patil, Kaitlin M. Woo, Maryann Carousso, Amanda Hughes, Joel Sheinfeld, Manjit Bains, Dean F. Bajorin, George J. Bosl, and Robert J. Motzer, Memorial Sloan Kettering Cancer Center; Darren R. Feldman, Dean F. Bajorin, George J. Bosl, and Robert J. Motzer, Weill Medical College of Cornell University, New York, NY; and James Hu, Tanya B. Dorff, Siamak Daneshmand, Charlene Ketchens, and David I. Quinn, University of Southern California Norris Comprehensive Cancer Center, Los Angeles, CA
| | - George J Bosl
- Darren R. Feldman, Kristina Lim, Sujata Patil, Kaitlin M. Woo, Maryann Carousso, Amanda Hughes, Joel Sheinfeld, Manjit Bains, Dean F. Bajorin, George J. Bosl, and Robert J. Motzer, Memorial Sloan Kettering Cancer Center; Darren R. Feldman, Dean F. Bajorin, George J. Bosl, and Robert J. Motzer, Weill Medical College of Cornell University, New York, NY; and James Hu, Tanya B. Dorff, Siamak Daneshmand, Charlene Ketchens, and David I. Quinn, University of Southern California Norris Comprehensive Cancer Center, Los Angeles, CA
| | - David I Quinn
- Darren R. Feldman, Kristina Lim, Sujata Patil, Kaitlin M. Woo, Maryann Carousso, Amanda Hughes, Joel Sheinfeld, Manjit Bains, Dean F. Bajorin, George J. Bosl, and Robert J. Motzer, Memorial Sloan Kettering Cancer Center; Darren R. Feldman, Dean F. Bajorin, George J. Bosl, and Robert J. Motzer, Weill Medical College of Cornell University, New York, NY; and James Hu, Tanya B. Dorff, Siamak Daneshmand, Charlene Ketchens, and David I. Quinn, University of Southern California Norris Comprehensive Cancer Center, Los Angeles, CA
| | - Robert J Motzer
- Darren R. Feldman, Kristina Lim, Sujata Patil, Kaitlin M. Woo, Maryann Carousso, Amanda Hughes, Joel Sheinfeld, Manjit Bains, Dean F. Bajorin, George J. Bosl, and Robert J. Motzer, Memorial Sloan Kettering Cancer Center; Darren R. Feldman, Dean F. Bajorin, George J. Bosl, and Robert J. Motzer, Weill Medical College of Cornell University, New York, NY; and James Hu, Tanya B. Dorff, Siamak Daneshmand, Charlene Ketchens, and David I. Quinn, University of Southern California Norris Comprehensive Cancer Center, Los Angeles, CA
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A Rare Case of Primary Anterior Mediastinal Yolk Sac Tumor in an Elderly Adult Male. Case Rep Oncol Med 2016; 2016:8961486. [PMID: 27144043 PMCID: PMC4837257 DOI: 10.1155/2016/8961486] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2016] [Accepted: 03/22/2016] [Indexed: 11/18/2022] Open
Abstract
Mediastinal germ cell tumors are extragonadal germ cell tumors (EGGCTs) commonly seen in children and young adults. They are more common in men. Clinically they are classified as teratomas, seminomas, and nonseminomatous germ cell tumors. Primary mediastinal yolk sac neoplasm is an extremely rare tumor. We present here a very rare case of primary yolk sac tumor of the anterior mediastinum in a 73-year-old male. Mediastinal germ cell tumors have a worse prognosis than gonadal germ cell tumors. Chemotherapy followed by adjuvant surgery improves overall response in EGGCTs. However, comorbidities can render treatment with chemotherapy and surgery challenging in elderly patients.
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