Huang Xiang, Zhang Rong, Zhou Liang-Fu
Department of Neurosurgery, Huashan Hospital, Fudan University, Shanghai 200040, China.
Zhonghua Yi Xue Za Zhi. 2009 Sep 8;89(33):2333-6.
To discuss the clinical feature, treatment and prognosis of intracranial nongerminomatous malignant germ cell tumors (NGMGCT).
The records of 39 patients receiving treatment at our hospital between 1995 and 2007 were reviewed retrospectively. According to the classification of Matsutani, they were grouped into intermediate prognosis and poor prognosis groups based on tumor histology. Clinical manifestations, diagnosis, treatment and outcome were analyzed in each group.
In these 39 cases, there were 15 mix germ cell tumors, 15 immature teratomas, 7 embryonal carcinomas and 2 yolk sac tumors. All patients were treated surgically. The tumor was totally removed in 29 cases, sub-totally in 5 and partially in 3. Biopsy was performed in the other 2 cases. Thirty-four patients (87.2%) were followed up. The overall 5-year survival rate was 36.8%. The 5-year actuarial survival rate for patients in the intermediate prognosis and poor prognosis groups were 42.6% and 0 respectively. Chemoradiotherapy had a significant correlation with the prognosis of intermediate prognosis group (P = 0.039). The 5-year survival rate of immature teratoma patients receiving post-operative gamma knife surgery was 100%. It had significant difference (P = 0.0049) as compared to the 5-year survival rate of patients receiving no gamma knife surgery.
NGMGCT can be divided into the intermediate and poor groups based on the prognosis (P = 0.0003). Embryonal carcinoma can be classified to the intermediate prognosis group because of its similar prognosis with immature teratoma and mixed tumors composed mainly of germinoma or teratoma. Surgery remains the first choice for NGMGCT since treatment should be based on tumor histology. For patients in the intermediate prognosis group, a combined regimen of surgical resection, radiotherapy, chemotherapy and gamma knife surgery is mostly effective.
探讨颅内非生殖细胞瘤性恶性生殖细胞肿瘤（NGMGCT）的临床特征、治疗方法及预后。
回顾性分析1995年至2007年在我院接受治疗的39例患者的病历资料。根据Matsutani分类法，依据肿瘤组织学将患者分为预后中等组和预后不良组。分析每组患者的临床表现、诊断、治疗及预后情况。
39例患者中，混合性生殖细胞肿瘤15例，未成熟畸胎瘤15例，胚胎癌7例，卵黄囊瘤2例。所有患者均接受手术治疗。肿瘤全切除29例，次全切除5例，部分切除3例，另2例行活检。34例患者（87.2%）获得随访。总体5年生存率为36.8%。预后中等组和预后不良组患者的5年精算生存率分别为42.6%和0。放化疗与预后中等组的预后显著相关（P = 0.039）。接受术后伽玛刀治疗的未成熟畸胎瘤患者5年生存率为100%，与未接受伽玛刀治疗患者的5年生存率相比有显著差异（P = 0.0049）。
NGMGCT可根据预后分为预后中等组和预后不良组（P = 0.0003）。胚胎癌因其预后与未成熟畸胎瘤及主要由生殖细胞瘤或畸胎瘤组成的混合性肿瘤相似，可归为预后中等组。手术仍是NGMGCT的首选治疗方法，治疗应基于肿瘤组织学。对于预后中等组患者，手术切除、放疗、化疗及伽玛刀联合治疗方案最为有效。
