Clinical characteristics and predictive factors of delayed diagnosis in patients with sellar germ cell tumors

Abstract

Purpose To investigate the clinical characteristics and predictive factors associated with delayed diagnosis in patients with sellar germ cell tumors (GCTs), aiming for early diagnosis. Methods A total of 345 patients with sellar GCTs were retrospectively collected. Patients were classified into a delayed diagnosis group (>6 months from onset to diagnosis) and a non-delayed diagnosis group (≤6 months). We compared general characteristics, clinical symptoms, diagnostic methods, treatment strategies, tumor prognosis, and pituitary function between the two groups. Predictive factors for delayed diagnosis were explored using multivariate logistic regression analysis. Results 225 patients (65.2%) experienced delayed diagnosis. Although there was no association between delayed diagnosis and survival rates or tumor recurrence rates, the delayed diagnosis group had a higher incidence of central diabetes insipidus, central adrenal insufficiency, central hypothyroidism, central hypogonadism, and growth hormone deficiency. Moreover, polyuria/polydipsia (OR 5.46; 95% CI 2.33-12.81), slow growth (OR 5.86; 95% CI 2.61-13.14), amenorrhea (OR 6.82; 95% CI 2.68-17.37), and germinoma (OR 4.99; 95% CI 1.08-3.61) were predictive factors for delayed diagnosis, while older age of onset (OR 0.88; 95% CI 0.84-0.94) and nausea/vomiting (OR 0.31; 95% CI 0.15-0.63) contributed to earlier diagnosis. Conclusion In patients with sellar GCTs, delayed diagnosis is common and linked to increased pituitary dysfunction. Factors predicting delayed diagnosis include slow growth, polyuria /polydipsia, amenorrhea, and germinomas with negative tumor markers. Early diagnosis is crucial to minimize the impact of sellar GCTs on pituitary function.