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Comparison of the clinical features and hematopoietic stem cell transplantation outcomes of mediastinal malignant germ cell tumors with nonmediastinal extragonadal placements

Authors Ocal N, Yildiz B, Karadurmus N, Dogan D, Ozaydin S, Ocal R, Ozturk M, Arpaci F, Bilgic H

Received 6 March 2016

Accepted for publication 21 July 2016

Published 9 December 2016 Volume 2016:9 Pages 7445—7450

DOI https://doi.org/10.2147/OTT.S107899

Checked for plagiarism Yes

Review by Single-blind

Peer reviewers approved by Dr Manfred Beleut

Peer reviewer comments 3

Editor who approved publication: Professor Min Li


Nesrin Ocal,1 Birol Yildiz,2 Nuri Karadurmus,2 Deniz Dogan,1 Sukru Ozaydin,2 Ramazan Ocal,3 Mustafa Ozturk,2 Fikret Arpaci,4 Hayati Bilgic1

1Department of Chest Diseases, 2Department of Oncology, Gulhane Military Medical Faculty, Ankara, Turkey; 3Department of Hematology, Medical Faculty, Gazi University, Ankara, Turkey; 4Department of Oncology, Liv Hospital, Ankara, Turkey

Objective: Even though the primary mediastinal extragonadal germ cell tumors (EGCTs) are rare, they are noteworthy in the differential diagnosis of mediastinal masses. In this study, we aimed to identify the clinical features of mediastinal malignant GCTs and compare the results of hematopoietic stem cell transplantation between mediastinal and nonmediastinal malignant EGCTs.
Method: Data of the patients with EGCT who were treated and underwent hematopoietic stem cell transplantation at our hospital between 1988 and 2015 were retrieved retrospectively. Results were compared between mediastinal and nonmediastinal EGCTs.
Results: Data of 65 patients diagnosed with EGCT (37 [56.92%] cases with mediastinal EGCT and 28 [43.07%] cases with nonmediastinal EGCT) were assessed. The clinical stages, frequency of pretransplant status, mean pretransplant time, and mean number of chemotherapy lines before hematopoietic stem cell transplantation were not significantly different between groups. Although the overall survival did not significantly differ between groups, the 5-year survival was significantly higher in mediastinal EGCTs (P=0.02). Yolk sac tumor was significantly more common in mediastinal EGCTs (P=0.05). Mortality rates were higher in seminomas and yolk sac tumors in all cases, higher in embryonal carcinomas in mediastinal EGCT group and higher in yolk sac tumors in nonmediastinal EGCT group. While choriocarcinomas had more aggressive courses in mediastinal EGCTs, seminomas and yolk sac tumors had poorer prognosis in nonmediastinal EGCTs. Short pretransplant time and persistence of elevated posttransplant βhCG and AFP levels were the significant mortality risk factors both in mediastinal and nonmediastinal EGCTs.
Conclusion: Mediastinal placement of EGCT was not a poor prognostic factor; furthermore, the 5-year survival was significantly higher in mediastinal EGCTs. According to our knowledge, this is the first study that compares the clinical outcomes of hematopoietic stem cell transplantation of mediastinal and nonmediastinal malignant EGCTs.

Keywords:
mediastinum, extragonadal germ cell tumor, hematopoietic stem cell transplantation, survival, tumor marker, βhCG, α-fetoprotein

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