Kumar Narendra, Madan Renu, Dracham Chinna Babu, Chandran Vigneshwaran, Elangovan Arun, Khosla Divya, Yadav Budhi Singh, Kapoor Rakesh
Department of Radiotherapy & Oncology, Post Graduate Institute of Medical Education and Research (PGIMER), Chandigarh, India.
Rare Tumors. 2020 Nov 18;12:2036361320972220. doi: 10.1177/2036361320972220. eCollection 2020.
Primary Mediastinal Germ Cell Tumor (PMGCT) is a rare and heterogeneous entity. These tumors are typically diagnosed in young adults and carry a poor prognosis. We conducted this study to evaluate the role of radiotherapy on treatment outcomes and prognostic factors in PMGCT that may allow a more adapted treatment strategy to improve survival. Case records of patients who presented with PMGCT over a period of 10-years from January-2009 to December-2019 were retrospectively evaluated. Survival analyses were calculated using Kaplan-Meier (Log-rank) method. Poor prognostic factors for survival were evaluated with Multivariate analysis using Cox-regression method. A total of 46-patients data was analyzed, the majority of the patients were males (95.7%) with a median age of 25-years (range, 17-62). Non-seminomatous histology was predominant (60.9%). Sixteen-patients (34.7%) presented with complications at their initial presentation. Majority of the patients were treated with multimodality approach using chemotherapy, surgery, and/or radiotherapy. At a median follow-up of 40.8 months, the 1, 3, and 5-year overall survival (OS) was 69.6%, 52.2%, and 44.7% respectively. Patients who received radiotherapy in first-line treatment showed significant improvement in 5-year OS (72% vs 30%, = 0.004) and disease-free survival (70% vs 24%, = 0.007) in comparison with patients who did not receive. Multivariate analysis revealed that radiotherapy, chemotherapy, surgery, and complications at presentation were independent prognostic factors for OS. PMGCTs are aggressive neoplasms especially in patients presenting with disease-related complications. Dual modality management (radiotherapy as local therapy along with chemotherapy) had shown improvement in survival.
原发性纵隔生殖细胞肿瘤（PMGCT）是一种罕见且异质性的疾病。这些肿瘤通常在年轻成年人中被诊断出来，预后较差。我们开展这项研究以评估放疗在PMGCT治疗结局中的作用以及可能有助于制定更合适治疗策略以提高生存率的预后因素。回顾性评估了2009年1月至2019年12月期间10年内出现PMGCT的患者的病例记录。使用Kaplan-Meier（对数秩）方法进行生存分析。使用Cox回归方法通过多变量分析评估生存的不良预后因素。共分析了46例患者的数据，大多数患者为男性（95.7%），中位年龄为25岁（范围17 - 62岁）。非精原细胞瘤组织学类型占主导（60.9%）。16例患者（34.7%）在初次就诊时出现并发症。大多数患者采用化疗、手术和/或放疗的多模式方法进行治疗。中位随访40.8个月时，1年、3年和5年总生存率（OS）分别为69.6%、52.2%和44.7%。与未接受放疗的患者相比，一线治疗接受放疗的患者5年总生存率（72%对30%，P = 0.004）和无病生存率（70%对24%，P = 0.007）有显著改善。多变量分析显示，放疗、化疗、手术和就诊时的并发症是总生存率的独立预后因素。PMGCT是侵袭性肿瘤，尤其是在出现与疾病相关并发症的患者中。双模式管理（放疗作为局部治疗联合化疗）已显示出生存率的改善。
