Gangadhar Bharath, Nagpal Chitrakshi, Sharma Aparna, Biswas Bivas, Roy Somnath, Bhagwat Aditya, Pushpam Deepam, Bakhshi Sameer, Kumar Sunil, Haresh Kunhi Parambath, Batra Atul
Medical Oncology, All India Institute of Medical Sciences, Delhi, India.
Medical Oncology, Tata Medical Center, Kolkata, India.
JCO Glob Oncol. 2025 Jul;11:e2500099. doi: 10.1200/GO-25-00099. Epub 2025 Jul 11.
Mediastinal germ cell tumors (GCTs) are rare malignancies, predominantly affecting young males, with limited real-world data on treatment outcomes in India. This study aimed to evaluate the clinical characteristics, treatment patterns, and survival outcomes of patients with mediastinal GCTs, emphasizing the effectiveness of first-line chemotherapy regimens.
A retrospective analysis was conducted on 81 patients diagnosed with mediastinal GCTs at two tertiary cancer centers in India from 2005 to 2023. Data on demographics, histological subtypes, presenting symptoms, treatment regimens, and outcomes were collected. Kaplan-Meier analysis was used to calculate progression-free survival (PFS) and overall survival (OS).
The median age at diagnosis was 26 years, with a male predominance (96.3%). Common histological subtypes included seminoma (34.3%) and yolk sac tumor (31.3%). First-line chemotherapy comprised bleomycin, etoposide, and cisplatin (BEP; 60.5%) and etoposide, ifosfamide, and cisplatin (VIP; 27.8%). Response rates included complete response (25.3%) and partial response (54.4%). After a median follow-up of 15 months, the median PFS and OS were not reached, with 2-year PFS and OS rates of 92.7% and 93.3%, respectively. Seminomas demonstrated better PFS compared with nonseminomatous GCTs ( = .004). Severe toxicities were observed in 48.1% of patients, with febrile neutropenia being the most common.
This study highlights the effectiveness of BEP and VIP chemotherapy in achieving high response rates and favorable survival outcomes in mediastinal GCTs. Early diagnosis, appropriate histological classification, and aggressive multimodal treatment strategies are essential for improving long-term outcomes in this predominantly young patient population. Further research is warranted to validate these findings and optimize therapeutic approaches.
纵隔生殖细胞肿瘤（GCTs）是罕见的恶性肿瘤，主要影响年轻男性，而印度关于其治疗结果的真实世界数据有限。本研究旨在评估纵隔GCTs患者的临床特征、治疗模式和生存结果，重点关注一线化疗方案的有效性。
对2005年至2023年在印度两家三级癌症中心诊断为纵隔GCTs的81例患者进行回顾性分析。收集了人口统计学、组织学亚型、症状表现、治疗方案和结果的数据。采用Kaplan-Meier分析计算无进展生存期（PFS）和总生存期（OS）。
诊断时的中位年龄为26岁，男性占主导（96.3%）。常见的组织学亚型包括精原细胞瘤（34.3%）和卵黄囊瘤（31.3%）。一线化疗包括博来霉素、依托泊苷和顺铂（BEP；60.5%）以及依托泊苷、异环磷酰胺和顺铂（VIP；27.8%）。缓解率包括完全缓解（25.3%）和部分缓解（54.4%）。中位随访15个月后，未达到中位PFS和OS，2年PFS和OS率分别为92.7%和93.3%。与非精原细胞瘤性GCTs相比，精原细胞瘤的PFS更好（P = 0.004）。48.1%的患者观察到严重毒性，发热性中性粒细胞减少最为常见。
本研究强调了BEP和VIP化疗在纵隔GCTs中实现高缓解率和良好生存结果方面的有效性。早期诊断、适当的组织学分类和积极的多模式治疗策略对于改善这一主要为年轻患者群体的长期结局至关重要。有必要进一步研究以验证这些发现并优化治疗方法。
