Pediatric Germ Cell Tumor Outcomes: Seer Database Analysis from 1973 TO 2005

Introduction: Pediatric non germinomatous germ cell tumors (NGGCT) occur rarely and single institutional experiences have been limited in their data. Open access databases; such as the Surveillance, Epidemiology, and End Results Program (SEER), tabulate U.S. population-based data and can clarify disease patterns, therapeutic interventions and outcomes for rare tumors. Germinomas are known to have favorable prognosis and are radiosensitive; the role of cytoreductive therapies for non-germinomatous tumors lacks substantive evidence.

Methods: Data from the SEER database was selected for patients with germ cell tumor for ages 0 to 17 years of age (n = 376). Interventions analyzed were extent of resection, chemotherapy and radiation therapy on overall survival for NGGCT, and subgroup analyses of mixed germ cell tumors and teratomas.

Results: Of 376 pediatric germ cell tumors, 143 were NGGCT. Of the NGGCT, 41 were mixed germ cell tumors, 72 were teratomas, and the rest included choriocarcinoma, dysgerminoma, embryonal carcinoma, teratocarcinoma, and yolk sac tumor.

Mean overall survival (OS) for non germinomatous tumors was 73.2 months. Mean OS for those receiving chemotherapy was 88.6 versus 53.3 months (p = 0.014). Mean OS for those receiving radiation was 93 versus 60 months (p = 0.022).

Mean OS for mixed germ cell tumors was 82 months. Chemotherapy did significantly improve OS (95 vs. 29 months, p = 0.024). Radiation did not significantly improve overall survival. Teratomas had an OS of 61.4 months. Radiation and chemotherapy did not have significant effect on OS for teratomas. Effects of extent of resection could not be adequately assessed due to the quality of the database.

Conclusion: NGGCT have a low incidence even in national databases our study was able to generate outcomes for NGGCT, mixed germ cell tumors and teratomas. NGGCT appeared to benefit from both chemotherapy and radiation but subgroup analyses indicate that mixed germ cell tumors benefit only from chemotherapy but not radiation. OS for teratoma is decidedly poor plausibly due to the aggressive behavior of immature teratomas; teratoma OS is not benefited by chemotherapy or radiation.