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

Camilo Vallejo-Yepes,Ricardo Brugés-Maya,José Alexander Carreño-Dueñas,Ricardo Buitrago,Rafael Beltrán-Jimenez,Carlos Andrés Carvajal-Fierro,Julian Beltrán

doi:10.3389/fonc.2021.758496

Camilo Vallejo-Yepes, Ricardo Brugés-Maya + Show 5 more

Open Access

https://doi.org/10.3389/fonc.2021.758496

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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.

Highlights

Germ cell tumors (GCT) are one of the leading causes of cancer in men between the ages of 15 and 35 [1], with most of these neoplasms arising from testicular sites
We believe that the reason for this is a high incidence of superior vena cava syndrome (SVCS) and extrapulmonary metastatic involvement in the study participants, which is higher when compared to the other series reported in the literature [12, 13]
We present one of the largest mediastinal GCT series in South America, with survival outcomes similar to other lower- and median-income countries

Summary

Introduction

Germ cell tumors (GCT) are one of the leading causes of cancer in men between the ages of 15 and 35 [1], with most of these neoplasms arising from testicular sites. In up to 5.7% of the patients, the tumor is localized in an extra-gonadal origin. In these cases, the anterior mediastinum constitutes the most frequent location [2]. Histology is not the only prognostic factor related to a lower probability of survival as other variables have been described. These include alpha-fetoprotein (AFP) or betahuman chorionic gonadotropin elevation after chemotherapy or incomplete tumor resection in the postoperative period, tumor viability in the pathology specimen after surgery, and induction chemotherapy [4,5,6]

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