纵隔恶性生殖细胞肿瘤与非纵隔性腺外部位生殖细胞肿瘤的临床特征及造血干细胞移植结局比较

Comparison of the clinical features and hematopoietic stem cell transplantation outcomes of mediastinal malignant germ cell tumors with nonmediastinal extragonadal placements.

作者信息

Ocal Nesrin, Yildiz Birol, Karadurmus Nuri, Dogan Deniz, Ozaydin Sukru, Ocal Ramazan, Ozturk Mustafa, Arpaci Fikret, Bilgic Hayati

机构信息

Department of Chest Diseases.

Department of Oncology, Gulhane Military Medical Faculty, Ankara, Turkey.

出版信息

Onco Targets Ther. 2016 Dec 9;9:7445-7450. doi: 10.2147/OTT.S107899. eCollection 2016.

DOI:10.2147/OTT.S107899

PMID:28003760

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC5158173/

Abstract

OBJECTIVE

Even though the primary mediastinal extragonadal germ cell tumors (EGCTs) are rare, they are noteworthy in the differential diagnosis of mediastinal masses. In this study, we aimed to identify the clinical features of mediastinal malignant GCTs and compare the results of hematopoietic stem cell transplantation between mediastinal and nonmediastinal malignant EGCTs.

METHOD

Data of the patients with EGCT who were treated and underwent hematopoietic stem cell transplantation at our hospital between 1988 and 2015 were retrieved retrospectively. Results were compared between mediastinal and nonmediastinal EGCTs.

RESULTS

Data of 65 patients diagnosed with EGCT (37 [56.92%] cases with mediastinal EGCT and 28 [43.07%] cases with nonmediastinal EGCT) were assessed. The clinical stages, frequency of pretransplant status, mean pretransplant time, and mean number of chemotherapy lines before hematopoietic stem cell transplantation were not significantly different between groups. Although the overall survival did not significantly differ between groups, the 5-year survival was significantly higher in mediastinal EGCTs (=0.02). Yolk sac tumor was significantly more common in mediastinal EGCTs (=0.05). Mortality rates were higher in seminomas and yolk sac tumors in all cases, higher in embryonal carcinomas in mediastinal EGCT group and higher in yolk sac tumors in nonmediastinal EGCT group. While choriocarcinomas had more aggressive courses in mediastinal EGCTs, seminomas and yolk sac tumors had poorer prognosis in nonmediastinal EGCTs. Short pretransplant time and persistence of elevated posttransplant βhCG and AFP levels were the significant mortality risk factors both in mediastinal and nonmediastinal EGCTs.

CONCLUSION

Mediastinal placement of EGCT was not a poor prognostic factor; furthermore, the 5-year survival was significantly higher in mediastinal EGCTs. According to our knowledge, this is the first study that compares the clinical outcomes of hematopoietic stem cell transplantation of mediastinal and nonmediastinal malignant EGCTs.

摘要

目的

尽管原发性纵隔性腺外生殖细胞肿瘤（EGCT）较为罕见，但在纵隔肿块的鉴别诊断中值得关注。在本研究中，我们旨在确定纵隔恶性生殖细胞肿瘤（GCT）的临床特征，并比较纵隔和非纵隔恶性EGCT造血干细胞移植的结果。

方法

回顾性检索1988年至2015年间在我院接受治疗并进行造血干细胞移植的EGCT患者的数据。比较纵隔和非纵隔EGCT的结果。

结果

评估了65例诊断为EGCT的患者的数据（37例[56.92%]为纵隔EGCT，28例[43.07%]为非纵隔EGCT）。两组之间的临床分期、移植前状态频率、平均移植前时间以及造血干细胞移植前化疗疗程的平均次数无显著差异。尽管两组的总生存率无显著差异，但纵隔EGCT的5年生存率显著更高（P=0.02）。卵黄囊瘤在纵隔EGCT中明显更常见（P=0.05）。在所有病例中，精原细胞瘤和卵黄囊瘤的死亡率较高，纵隔EGCT组中胚胎癌的死亡率较高，非纵隔EGCT组中卵黄囊瘤的死亡率较高。虽然纵隔EGCT中绒毛膜癌的病程更具侵袭性，但非纵隔EGCT中精原细胞瘤和卵黄囊瘤的预后较差。移植前时间短以及移植后βhCG和AFP水平持续升高是纵隔和非纵隔EGCT的显著死亡风险因素。