Dataset Information

Outcomes After Multidisciplinary Management of Primary Mediastinal Germ Cell Tumors.

ABSTRACT:

Objective

We examined management strategies, overall survival (OS), and progression-free survival (PFS) among patients with PMNSGCTs undergoing resection and multidisciplinary management at a high-volume institution.

Summary of background data

Outcomes after resection of PMNSGCTs are not well-characterized, with limited data on factors associated with survival.

Methods

We reviewed patients with PMNSGCT who underwent resection between 1980 and 2019. Median follow-up was 3.4 years. Preoperative therapy (including use of bleomycin), surgical management, recurrence, and survival were examined. Factors associated with survival were analyzed using Cox regression.

Results

In total, 113 patients were included [median age, 28 years (range, 16-65)]. Preoperative serum tumor markers (STMs) normalized/decreased in 74% of patients. Pathology included necrosis only (25%), teratoma +/- necrosis (20%), viable nonteratomatous germ cell tumor +/- teratoma (41%), and secondary somatic-type malignancy +/- teratoma (20%). Bleomycin chemotherapy was not associated with pulmonary complications or 90-day mortality. Patients receiving second-line chemotherapy followed by resection had significantly worse OS and PFS than patients receiving first-line chemotherapy followed by resection. On multivariable analysis, R1/R2 resection (HR, 3.92; P < 0.001) and increasing postoperative STMs (HR, 4.98; P < 0.001) were associated with shorter PFS; necrosis on pathology (HR, 0.42, P = 0.043) was associated with longer PFS.

Conclusions

In patients with PMNSGCT undergoing resection, completeness of resection, postoperative pathology, and postoperative STMs were associated with PFS. Induction bleomycin was not associated with pulmonary complications or mortality in patients undergoing resection. Patients undergoing second-line chemotherapy followed by resection have a poor prognosis, with long-term survival of 22%.

SUBMITTER: Caso R

PROVIDER: S-EPMC7371518 | biostudies-literature | 2021 Dec

REPOSITORIES: biostudies-literature

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Publications

Outcomes After Multidisciplinary Management of Primary Mediastinal Germ Cell Tumors.

Caso Raul R Jones Gregory D GD Bains Manjit S MS Hsu Meier M Tan Kay See KS Feldman Darren R DR Funt Samuel A SA Reuter Victor E VE Bosl George J GJ McHugh Deaglan D Huang James J Molena Daniela D Amar David D Fischer Gregory G Rusch Valerie W VW Jones David R DR

Annals of surgery 20211201 6

<h4>Objective</h4>We examined management strategies, overall survival (OS), and progression-free survival (PFS) among patients with PMNSGCTs undergoing resection and multidisciplinary management at a high-volume institution.<h4>Summary of background data</h4>Outcomes after resection of PMNSGCTs are not well-characterized, with limited data on factors associated with survival.<h4>Methods</h4>We reviewed patients with PMNSGCT who underwent resection between 1980 and 2019. Median follow-up was 3.4 ...[more]

PMID: 31977510

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Project description:Background Primary mediastinal germ cell tumors (PMGCT) represent a rare but sometimes highly aggressive type of mediastinal tumors. The current prognostic models for PMGCT are insufficient. This study was undertaken to establish and validate an individualized nomogram for predicting the overall survival (OS) of patients with PMGCT. Methods We conducted a retrospective analysis of patients with PMGCT diagnosed between 2000 and 2018 in the Surveillance, Epidemiology, and End Results (SEER) database in the United States. Clinical variables included surgery subtype, gender, treatment regimens, age, histology, tumor size, stage, chemotherapy, radiation, race, and survival-related information. The main outcome measure was survival duration. The Kaplan-Meier method along with the log-rank test were utilized to estimate the OS. Independent prognostic factors were identified by performing the univariate and multivariate Cox proportional hazards regression analyses, from which an individualized nomogram was constructed to predict 3-, 5-, and 10-year OS of patients with PMGCT. The concordance index (C-index) and calibration curve were used to verify the discrimination and accuracy of the nomogram. Results A total of 845 patients with PMGCT were recruited from the SEER database and further randomly assigned to a training set (n=635) and a validation set (n=210) at a ratio of 7:3. The 3-, 5-, and 10-year OS for overall PMGCT was 70.0%, 67.1%, and 63.9%, respectively. Cox regression analysis indicated that age, tumor size, stage, chemotherapy, radiation, histology, and surgery type were as independent factors for OS in patients with PMGCT (P<0.05). An individualized nomogram for OS was constructed utilizing these variables, with the C-index of 0.714 [95% confidence interval (CI): 0.695 to 0.743] and 0.756 (95% CI: 0.735 to 0.787) in the training and validation groups. Moreover, good levels of agreement were observed according to the calibration curve between the predicted and actual 3-, 5-, and 10-year survival rates both in the training and validated cohorts, showing that the model could accurately predict patient prognosis. Conclusions This study documented the first attempt at establishing and validating a novel nomogram for predicting the 3-, 5-, and 10-year OS probabilities of PMGCT. The prognostic nomogram was demonstrated to have good performance for predicting individualized OS of patients with PMGCT.

Dataset Information

Outcomes After Multidisciplinary Management of Primary Mediastinal Germ Cell Tumors.

Objective

Summary of background data

Methods

Results

Conclusions

Publications

Outcomes After Multidisciplinary Management of Primary Mediastinal Germ Cell Tumors.

Similar Datasets

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