Grading System For Diagnosis And Treatment Of Intracranial Nongerminomatous Malignant Germ Cell Tumors

Object:To discuss the clinical feature,treatment,and prognosis of intracranial nongerminomatous malignant germ cell tumors(NGMGCTs).Methods:The records of 39 patients who were treated in Shanghai Huashan hospital between 1995 and 2007 were reviewed retrospectively.According to the classification of Matsutani in 1997,they were grouped into intermediate prognosis group and poor prognosis group based on the histology of the tumor.Clinical manifestation,diagnosis, treatment and outcome were analysis in each group.Results:In these 39 cases,there were 15 mix germ cell tumors,15 immature teratomas, 7 embryonal carcinomas and 2 yolk sac tumors.All patients were treated surgically.The tumor was totally removed in 29 cases,sub-totally in 5,and partially in 3.Biopsy was performed in the other 2 cases.34 patients(87.2%) were followed up.The common 5-year survival rate was 36.8%.The 5-year actuarial overall survival rate for patients in the intermediate prognosis and poor prognosis groups were 42.6%and 0%. Chemotherapy combined radiotherapy has significant relationship with the prognosis of intermediated prognosis group(P=0.039).The 5-year survival rate of immature teratoma patients who received gamma knife surgery after surgery was 100%.It had significant difference(P=0.0049) compared to the 5-year survival rate of patients who did not receive gamma knife surgery.Conclusions:NGMGCTs can be divided into intermediate group and poor group base on the prognosis(P=0.0003).Embryonal carcinoma can be classified to the intermediate prognosis group because of its similar prognosis with immature teratoma and mixed tumors mainly composed of germinoma or teratoma.Surgery is the first choice for NGMGCTs because treatment should be base on tumor histology.For patients in the intermediate prognosis group,combined treatment,including surgical resection, radiotherapy,chemotherapy and gamma knife surgery was effective.