GCT-07. CONTRIBUTORS TO DELAYED TREATMENT OF NON-GERMINOMATOUS GERM CELL TUMORS IN CHINA: A TERTIARY-CENTER REVIEW

Abstract

Abstract BACKGROUND Non-Germinomatous Germ Cell Tumors (NGGCT) are rare malignancies with potential for treatment delays. This study aims to identify risk factors and systemic challenges contributing to delayed management of NGGCT in China. METHODS We reviewed the clinical features and referral pattern of 56 consecutively diagnosed NGGCT patients at Shanghai Children’s Medical Center (SCMC) from 9/2018-2/2023. Patients were diagnosed by pathology (n=42), or by elevated markers alone (n=14, AFP>10ng/ml, and/or β-HCG>50mIU/ml). Patients were treated per COG ACNS0122. Delay of treatment was defined as chemotherapy initiated more than 6 months after symptom onset. RESULTS Forty-three males and 13 females were included. Median age at diagnosis was 9.17year (4month-16year). Primary tumor locations included the pineal region (n=31), sellar region (n=19), basal ganglia (n=5), and posterior fossa (n=1). Presenting symptoms included features of increased intracranial pressure (ICP, n=29), endocrine symptoms (n=21), blurred vision or squint (n=7), and hemiplegia (n=4). Delayed treatment occurred in 16 cases (29%), and was more likely in patients with non-pineal region primary (Chi-square p=0.003), and absence of symptoms pertaining to increased ICP (Chi-square p<0.001). Reasons for delay included lack of parental recognition on symptoms (n=7), misdiagnosis (n=3), and inappropriate/incomplete workup (n=6). As a national referral center, patients commuted a median of 483 km (range: 12-2943km) to SCMC (median 2 hospitals (1,5) before SCMC), including 10 patients with obvious hydrocephalus travelling before any CSF diversion procedure. Three-year Event-Free Survival (EFS) was 76.9% and Overall Survival was 86.0%. There was a trend to inferior outcome in patients with delay in treatment (3y EFS 69.6%) compared with those without (3year EFS 80.6%, p=0.112). CONCLUSIONS Delay in treatment is common for children with NGGCT managed at a tertiary referral center in China. Improving public awareness, training for primary-care clinicians, and establishing a national referral network are potential strategies to enhancing the outcome.