A prognostic model including pre- and postsurgical variables to enhance risk stratification of primary mediastinal nonseminomatous germ cell tumors: the 27-year experience of a referral center

Clin Genitourin Cancer. 2015 Feb;13(1):87-93.e1. doi: 10.1016/j.clgc.2014.06.014. Epub 2014 Jun 24.


Background: Primary mediastinal germ cell tumors (PMGCTs) poorly benefit from chemotherapy and half of patients die because of disease progression. Enhancing the risk stratification might result in tailoring a more personalized treatment strategy from the time of diagnosis.

Patients and methods: Between the years 1985 and 2012, 86 patients with PMGCT were treated at our center. Cox proportional hazards regression analysis was conducted in the population of nonseminomas to examine the prognostic effect of candidate factors on progression-free and OS. OS curves were compared using the Kaplan-Meier method and the log-rank test.

Results: Mean age was 29.8 years (range, 15-63 years). Twenty-five patients (29.1%) had lung and 8 (9.3%) liver, bone, or brain metastases. Twelve patients (13.9%) received upfront high-dose chemotherapy and 45 patients (52.3%) underwent surgery after chemotherapy. Cox analyses included 61 evaluable primary mediastinal nonseminomatous germ cell tumors (PMNSGCTs). The final model of factors indicating a poor prognosis included the combination of surgery and histological response (overall P = .011) and lung metastases (hazard ratio, 3.03; 95% confidence interval, 1.12-8.15; P = .028). The model showed a bootstrap-corrected Harrel c-statistic for OS of 0.66. A risk stratification model based on the combination of these factors and accounting for a 50% 5-year survival cutoff identified 2 groups (poor prognosis, n = 33 vs. good prognosis, n = 28) with distinct OS curves (P < .001). Preoperative serum tumor marker level was not associated with the final histology (P = .853, χ(2) test). Results were limited by small numbers.

Conclusion: Patients with PMNSGCT included 2 subpopulations with distinct prognosis, and therapeutic improvements are needed for patients with poor-risk features.

Keywords: Lung metastases; Mediastinal germ cell tumors; Pathological response; Prognostic factors; Surgery.

MeSH terms

  • Adolescent
  • Adult
  • Humans
  • Lung Neoplasms / pathology
  • Lung Neoplasms / secondary
  • Male
  • Mediastinal Neoplasms / drug therapy
  • Mediastinal Neoplasms / pathology*
  • Mediastinal Neoplasms / surgery*
  • Middle Aged
  • Neoplasms, Germ Cell and Embryonal / drug therapy
  • Neoplasms, Germ Cell and Embryonal / pathology*
  • Neoplasms, Germ Cell and Embryonal / surgery*
  • Precision Medicine
  • Prognosis
  • Regression Analysis
  • Risk
  • Survival Analysis
  • Tertiary Care Centers
  • Testicular Neoplasms
  • Young Adult

Supplementary concepts

  • Nonseminomatous germ cell tumor