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Outcomes of intracranial non-germinomatous germ cell tumors: a retrospective Asian multinational study on treatment strategies and prognostic factors

 Kyung Taek Hong  ;  Jung Woo Han  ;  Hiroshi Fuji  ;  Hwa Kyung Byun  ;  Kyung-Nam Koh  ;  Ru Xin Wong  ;  Hsin-Lun Lee  ;  Hong In Yoon  ;  Joo Ho Lee  ;  Ji Hoon Phi  ;  Seung-Ki Kim  ;  Dong-Seok Kim  ;  Chuhl Joo Lyu  ;  Jung Yoon Choi  ;  Hyoung Jin Kang  ;  Yi-Wei Chen  ;  Yi-Yen Lee  ;  Ho Joon Im  ;  Young-Shin Ra  ;  Seung Do Ahn  ;  Sharon Yin Yee Low  ;  Wen Shen Looi  ;  Hyeon Jin Park  ;  Yang-Gun Suh  ;  Chang-Ok Suh  ;  Kyu-Chang Wang  ;  Enrica Ee Kar Tan  ;  Tai-Tong Wong  ;  Joo-Young Kim 
 JOURNAL OF NEURO-ONCOLOGY, Vol.160(1) : 41-53, 2022-10 
Journal Title
Issue Date
Brain Neoplasms* / drug therapy ; Brain Neoplasms* / therapy ; Child ; Chorionic Gonadotropin, beta Subunit, Human ; Germinoma* / pathology ; Humans ; Male ; Neoplasms, Germ Cell and Embryonal* / diagnosis ; Neoplasms, Germ Cell and Embryonal* / therapy ; Prognosis ; Retrospective Studies
Central nervous system ; Event-free survival ; Non-germinomatous germ cell tumor ; Overall survival ; Prognostic factor
Purpose: Non-germinomatous germ cell tumors (NGGCTs) are rare pediatric conditions. This multicenter study using Asian multinational patient data investigated treatment outcomes and prognostic factors for NGGCTs.

Methods: Medical records of 251 patients with NGGCTs treated from 1995 to 2015 were retrospectively analyzed from participating centers in Asian countries (Korea, Taiwan, Singapore, and Japan).

Results: The median follow up was 8.5 years (95% CI 7.8-9.9). In the total cohort, 5-year event-free survival (EFS) and overall survival (OS) rates were 78.2% and 85.4%, respectively. In 17.9% of the patients, diagnosis was determined by tumor markers alone (alpha-fetoprotein ≥ 10 ng/mL (Korea) or > 25 ng/mL (Taiwan and Singapore), and/or β-human chorionic gonadotropin (β-hCG) ≥ 50 mIU/mL). Patients with immature teratomas and mature teratomas comprised 12.0% and 8.4%, respectively. The 5-year EFS rate was higher in patients with histologically confirmed germinoma with elevated β-hCG (n = 28) than those in patients with malignant NGGCTs (n = 127). Among malignant NGGCTs, patients with choriocarcinoma showed the highest 5-year OS of 87.6%, while yolk sac tumors showed the lowest OS (68.8%). For malignant NGGCT subgroups, an increase in serum β-hCG levels by 100 mIU/mL was identified as a significant prognostic factor associated with the EFS and OS.

Conclusion: Our result shows excellent survival outcomes of overall CNS NGGCT. However, treatment outcome varied widely across the histopathologic subgroup of NGGCT. Hence, this study suggests the necessity for accurate diagnosis by surgical biopsy and further optimization of diagnosis and treatment according to the histopathology of NGGCTs. Future clinical trials should be designed for individualized treatments for different NGGCTs subsets.
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1. College of Medicine (의과대학) > Dept. of Neurosurgery (신경외과학교실) > 1. Journal Papers
1. College of Medicine (의과대학) > Dept. of Pediatrics (소아과학교실) > 1. Journal Papers
1. College of Medicine (의과대학) > Dept. of Radiation Oncology (방사선종양학교실) > 1. Journal Papers
Yonsei Authors
Kim, Dong Seok(김동석)
Byun, Hwa Kyung(변화경) ORCID logo https://orcid.org/0000-0002-8964-6275
Lyu, Chuhl Joo(유철주) ORCID logo https://orcid.org/0000-0001-7124-7818
Yoon, Hong In(윤홍인) ORCID logo https://orcid.org/0000-0002-2106-6856
Han, Jung Woo(한정우) ORCID logo https://orcid.org/0000-0001-8936-1205
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