Survival outcomes and prognostic factors of extragonadal germ cell tumors: An institutional experience over a decade.

Abstract

Background: Extra gonadal germ cell tumors (EGCT) are rare tumors with late presentation to the oncologist. Though they respond well to chemotherapy, cure is compromised in the real world due to various factors. This study was undertaken to assess the clinical profile, survival outcomes and factors effecting outcomes of extragonadal germ cell tumors in men.

Patients and methods: This is a retrospective study of male extra gonadal germ cell tumors diagnosed and treated from January 2011 to December 2021. Patient demographics, tumor characteristics and treatment details were retrieved from case records.

Statistical analysis: Kaplan-Meier estimates of survival was used for survival analysis. Cox regression model was used to analyze the prognostic factors using SPSS version 25.

Results: A total of 32 patients were analyzed. The median age at presentation was 26 years (range:13-40years). Primary site of the disease was mediastinal in 25patients (78%), retroperitoneal in 4(12%) and intracranial in 3patients (10%). Histology was non seminomatous in majority of mediastinal tumors (15 patients (60%)) while all the retroperitoneal tumors were non seminomatous. Ninety four percent of the patients completed the planned cycles of chemotherapy. BEP was the most common chemotherapy regimen used (n-21 ,65%). Post chemotherapy residual disease was present in 13 patients (10 nonseminomatous, 3 seminomatous), who underwent surgery (9 patients) and radiotherapy (3patients). Median time to relapse was 8 months (range 1-11). Univariate analysis showed that nonseminoma histology, mediastinal site, post chemotherapy elevated tumor markers, Eastern Cooperative Oncology Group performance status (ECOG PS) more than 2, poor risk on International Germ Cell Cancer Collaborative Group (IGCCCG) risk stratification were associated with inferior outcomes. On multivariate analysis, non-seminoma histology, mediastinal site, ECOG PS >2 and IGCCCG poor risk were associated with statistically inferior OS. At a median follow up of 65 months (range 1-132 months) 2-year PFS and OS were both 100% in seminoma and both 65% in non-seminoma.

Conclusions: Mediastinum is the most common site of EGCT. Site of the primary, non-seminoma histology, poor performance status and poor risk disease are factors contributing to inferior outcome and high mortality. Early medical attention and newer salvage therapies for refractory disease are needed to improve the survival of these patients.