Survival Outcomes of Patients With Mediastinal Germ Cell Tumors: Experience of a Cancer Center in South America

Abstract

PurposeMediastinal germ cell tumors (GCT) are rare neoplasms associated with poor survival prognosis. Due to their low incidence, limited information is available about this disease in South America. The objective of this study is to report the clinical characteristics and outcomes of patients with mediastinal GCT in a cancer center in Colombia.Materials and MethodsWe conducted a retrospective analysis of patients with mediastinal GCT treated at the National Cancer Institute at Bogota (Colombia) between 2008 and 2020. Survival curves were presented using the Kaplan–Meier method. Chi-square and Cox proportional hazard model tests were used for data analysis.ResultsSixty-one patients were included in the study. Of them, 60 were male and 51 (83.6%) of whom had non-seminomatous germ cell tumors (NSGCT). Twenty-nine patients (47.5%) presented with superior vena cava syndrome, and 18 (29.5%) patients had extrapulmonary metastatic involvement. The three-year overall survival (OS) of NSGCT patients was 26%. The 3-year OS of NSGCT patients who underwent surgical resection of residual mediastinal mass after chemotherapy was 59%. Non-surgical management after first-line chemotherapy was associated with a worse survival prognosis in NSGCT patients (p = 0.002). Ten patients with mediastinal seminomatous germ cell tumors (SCGT) achieved a 3-year OS of 100%.ConclusionMediastinal NSGCT had poor outcomes. Surgery of the residual mass after first-line chemotherapy seems to improve the outcome of NSGCT patients. Advanced disease at presentation may reflect inadequate access to reference cancer centers in Colombia and potentially explain poor survival outcomes in this cohort. On the other hand, mediastinal SCGT is a biologically different disease; most patients will achieve disease remission and long-term survival with first-line chemotherapy.

Primary Mediastinal Dysgerminoma: A Case Report and Literature Review

“…Mediastinal seminomatous germ cell tumors are tumors with a higher probability of response to chemotherapy and a better prognosis [15]. Prognostic factors reported based on a retrospective analysis of 31 patients included histological type, surgical resection of the tumor, and less than 10% viable tumor cells present in the resection material, as well as a classification according to the IGCCCG as having a good prognosis [16].…”

Metastatic right atrial mass in the presence of atrial septal defect: A rare clinical coincidence

“…However, a favorable response was obtained with an update on the regimen. Ultimately, Mediastinal GCTs typically have unfavorable prognoses, and based on a recent study, 17 the three‐year OS rate for patients with non‐seminomatous GCT (NSGCT) is only 26%. The 3‐year OS rate of patients with NSGCT who had surgery to remove the remaining mediastinal tumor following receiving chemotherapy is about 59%.…”

Primary germ cell tumours of the mediastinum: A review with emphasis on diagnostic challenges

“…PMSEMs show a much better long‐term PFS and OS in comparison to PMECs, PMYSTs and PMGCTs, with approroximately 95%, respectively, because of their good response to CT and radiation 117,211,231–233 . A worse prognosis is associated with visceral metastases or more than two metastatic sites 211 .…”

“…A worse prognosis is associated with visceral metastases or more than two metastatic sites 211 . Long‐term PFS in high risk PMGCTs is approximately 35–45% for PMNSGCTs, 211,231,232,234,235 where PMYSTs have a better prognosis than PMECs and PMCCs 236 . PMCCs have the worst prognosis, because they often show haematogenous spread and distant metastases at the time of diagnosis 93,237–239 .…”

“…230 PMSEMs show a much better long-term PFS and OS in comparison to PMECs, PMYSTs and PMGCTs, with approroximately 95%, respectively, because of their good response to CT and radiation. 117,211,[231][232][233] A worse prognosis is associated with visceral metastases or more than two metastatic sites. 211 Long-term PFS in high risk PMGCTs is approximately 35-45% for PMNSGCTs, 211,231,232,234,235 where PMYSTs have a better prognosis than PMECs and PMCCs.…”