Predictors of long-term survival following postoperative radiochemotherapy for pathologically confirmed suprasellar germ cell tumors

Abstract

The aim of this study was to evaluate the predictors of long-term survival following postoperative therapy for suprasellar germ cell tumors (GCTs). A total of 23 patients with pathologically confirmed suprasellar GCTs were reviewed between April, 1987 and October, 2008. The predictors were identified with a univariate Cox proportional hazards model and the results were used to group patients according to outcome. The overall survival (OS) and progression-free survival (PFS) rates for the good- and poor-prognosis two groups were estimated with Kaplan-Meier analysis, with log-rank tests used to assess differences between the groups. The OS rate for all patients was 82.6% at 5 and 72.9% at 10 years. Lesion size (2-4 vs. >4 cm) and pathological type (pure germinoma vs. mixed GCT) were the only significant predictors of OS (P<0.05). The OS rate for the good-prognosis group was 92.9% at both 5 and 10 years, whereas the corresponding rates for the poor-prognosis group were 66.7 and 40.0%, respectively (P=0.020). The PFS rate for the good-prognosis group was 92.9% at 5 and 85.7% at 10 years, whereas the corresponding PFS rates for the poor-prognosis group were 44.4 and 33.3%, respectively (P=0.007). Lesion size and histology predicted outcome following postoperative therapy for suprasellar GCT. Therefore, pathological diagnosis is recommended whenever possible, as histology may dictate the choice of treatment.

Treatment Outcome in Patients with Primary Central Nervous System Germ Cell Tumour: Clinical Experience from a Regional Cancer Centre in North India

“…In general, patients with germinoma have a better prognosis compared to patients with NGGCT [3,12] . The syncytiotrophoblastic variant of germinoma carries a less favourable prognosis than pure germinoma [4] .…”

“…The median age at presentation in our study was 13 years. Germinoma is more common in older patients and NGGCT is more common in younger patients [1][2][3] .…”

“…The common symptoms at presentation include features of raised intracranial tension, such as headache, vomiting, lethargy, visual abnormalities, e.g., Parinaud's syndrome (due to dorsal midbrain compression by pineal tumour) and visual field deficit (due to optic chiasma compression by suprasellar tumour), and endocrine abnormalities, e.g., diabetes insipidus, amenorrhoea, and precocious puberty [1][2][3] . Headache, visual problems, and vomiting were the common symptoms in our series, being present in 80, 70, and 45% of the patients, respectively.…”

“…In our study, a male sex predilection (male:female = 7: 3) was also seen. Patients commonly present in the 2nd decade with the peak incidence being at 10-12 years [1][2][3] . The median age at presentation in our study was 13 years.…”

“…These share morphologic, genetic, and therapeutic similarities to gonadal GCT [1] . The majority of the intracranial GCT arise from primordial germ cells in structures around the third ventricle [3] . The most common sites are the pineal gland and the suprasellar region [1,2,4,5] .…”