Prognostic Factors in Children With Extragonadal Malignant Germ Cell Tumors: A Pediatric Intergroup Study
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Published:2006-06-01
Issue:16
Volume:24
Page:2544-2548
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ISSN:0732-183X
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Container-title:Journal of Clinical Oncology
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language:en
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Short-container-title:JCO
Author:
Marina Neyssa1, London Wendy B.1, Frazier A. Lindsay1, Lauer Stephen1, Rescorla Frederick1, Cushing Barbara1, Malogolowkin Marcio H.1, Castleberry Robert P.1, Womer Richard B.1, Olson Thomas1
Affiliation:
1. From the Stanford University Medical Center, Stanford, CA; University of Florida and Children's Oncology Group Statistics and Data Center, Gainesville, FL; Dana-Farber Cancer Center, Boston, MA; Children's Healthcare of Atlanta at Egleston, Atlanta, GA; Indiana University Riley Children's Hospital, Indianapolis, IN; Wayne State University School of Medicine and Children's Hospital of Michigan, Detroit, MI; Children's Hospital Los Angeles, Los Angeles, CA; University of Alabama at Birmingham, AL; and the...
Abstract
Purpose To investigate prognostic factors for pediatric extragonadal malignant germ cell tumors (PEMGCT). Materials and Methods Between 1990 and 1996, patients with stage I through IV PEMGCT were eligible for a trial of cisplatin dose intensity. We retrospectively investigated prognostic factors for PEMGCT, including age, stage, primary site, treatment, and elevated alfa fetoprotein by univariate and multivariate analysis. Results The 165 patients had a median age of 1.9 years (range, 3 days to 18.5 years); 109 were female; and 99 had alfa fetoprotein ≥ 10,000. There were 30 stage I/II, 61 stage III, and 74 stage IV tumors; primary sites included 88 sacrococcygeal, 39 thoracic, and 38 others. The 5-year overall survival (OS) and event-free survival (EFS) rates with standard deviations were 83.4% ± 3.7% and 79.0% ± 4.1%, respectively. Univariate analysis identified age ≥ 12 years as a highly significant prognostic factor for EFS (5-year EFS, 48.9% ± 15.6% v 84.1% ± 3.9%; P < .0001) and for OS (5-year OS, 53.7% ± 14.9% v 88.5% ± 3.4%; P < .0001), whereas treatment was of borderline significance (P = .0777). Multivariate Cox proportional hazards regression identified only age ≥ 12 years as a significant prognostic factor for EFS (P = .0002). In multivariate Cox regression for OS, the combination of age and primary site was highly significant (P < .0001). Patients ≥ 12 years of age with thoracic tumors had six times the risk of death compared with patients younger than 12 years with other primaries. Conclusion Age is the most predictive factor of EFS in PEMGCT. There is a significant interaction between age and primary site, suggesting that patients ≥ 12 years of age with thoracic tumors are a biologically distinct group.
Publisher
American Society of Clinical Oncology (ASCO)
Subject
Cancer Research,Oncology
Reference29 articles.
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