| Background and ObjectiveGerm cell tumors(GCTs)refers to a group of tumors formed by primordial pluripotent germ cells during the differentiation,maturation and migration process.Clinical manifestations are diverse.At present,the systematic clinical research on the disease is not complete.The clinical data of children with malignant germ cell tumors diagnosed and treated in Qilu Hospital of Shandong University from January 2010 to February 2022 were retrospectively analyzed,and their clinical data were summarized.To explore the relevant factors affecting the prognosis and improve its diagnosis and treatment effect.MethodsThe clinical data of children with malignant germ cell tumors aged 0-18 years who were diagnosed in Qilu Hospital of Shandong University from January 2010 to February 2022 were collected,including children’s age,gender,clinical manifestations,physical examination signs,auxiliary examinations,diagnostic methods,treatment methods,pathological types,related complications and prognosis of children.For the children treated in our hospital,the risk factors affecting their prognosis were analyzed.Statistical analysis was performed using SPSS 23.0 software.The enumeration data were expressed as rate(%),and the comparison between the two sample rates was performed using the chi-square test or Fisher’s exact test.The Kaplan Meier method was used to calculate the 2-year overall survival(OS)rate and the EFS rate,and the log-rank test was used to analyze the influence of single factor on the 2-year overall survival(OS)rate and event-free survival(EFS)rate of the children.P<0.05 was considered statistically significant.ResultsA total of 139 children with GCTs were collected,including 60 males(43.2%)and 79 females(56.8%),with a male to female ratio of 1:1.31.The onset age covered all ages from 0 to 18 years,with a median onset age of 6 years and 4 months.The site of the disease involves multiple organs throughout the body.There were 40 cases of primary intracranial lesions(sellar region in 16 cases,pineal gland in 13 cases,basal ganglia in 4 cases,parietal lobe in 1 case,third ventricle in 1 case,multiple intracranial lesions in 8 cases).There were 96 cases of extracranial primary disease(testicular 27,ovarian 25,sacral caudal 18,abdominal cavity 8,pelvic cavity 6,retroperitoneal 3,vagina 3,adnexal region 2,parotid gland 1,thoracic vertebra 1,uterus 1,multiple extracranial 1).Local mass is the most common first symptom(41%),followed by gastrointestinal symptoms such as nausea,vomiting and diarrhea,abdominal pain,and central nervous system symptoms such as headache and dizziness.All 139 children received imaging examination at initial diagnosis.MRI was the most commonly used imaging examination method for children with GCTs,and 52 children received MRI examination,followed by CT in 49 cases,ultrasound in 34 cases,ECT 7 cases,and X-ray in 1 case.Through physical examination and imaging examination,it was finally confirmed that the tumor length was greater than or equal to 10cm in 24 children,and less than 10cm in 115 children.121 children were diagnosed by pathology,and 18 children with intracranial GCT were not diagnosed by pathology due to the complex anatomical conditions of tumor location.The tumor pathological subtypes included 57 yolk sac tumors,26 immature teratomas,15 unclassified germ cell tumors,10 mixed germ cell tumors,11 dysgerminomas,and 2 seminomas.Among them,91 cases received treatment in Qilu hospital,73 cases received surgical treatment(total resection was performed in 62 cases,partial resection and puncture biopsy in 11 cases),71 received chemotherapy(operation combined with chemotherapy in 62 cases,radiotherapy combined with chemotherapy in 5 cases,chemotherapy alone in 4 cases),25 received radiotherapy(surgery combined with radiotherapy in 11 cases,radiotherapy combined with chemotherapy in 5 cases and radiotherapy alone in 9 cases).The median follow-up time was 27 months.The 2-year OS rate was 94.5%and EFS rate was 81.3%.Different primary site,gender,delayed visit time,tumor type,tumor diameter,treatment method,levels of tumor markers such as AFP and β-HCG,levels of endocrine hormones such as prolactin and other factors,the 2-year OS rate and EFS of children were no significant effect on the rate,and the difference was not statistically significant(P>0.05).The 2-year EFS rate of children with incomplete resection and early metastasis was significantly reduced,with statistical significance(P<0.05).Conclusion1.Germinoma can occur at all ages from 0 to 18 years old,with two peaks of onset in infancy and adolescence.The incidence sites are mostly located at the median line of the body,and the clinical manifestations are atypical and diverse.The prognosis is good after comprehensive treatment combined with surgery,chemotherapy and radiotherapy.2.Different primary site,gender,delayed visit time,tumor pathological subtype,tumor diameter,tumor marker levels such as AFP and β-HCG,endocrine hormone levels such as prolactin,and treatment methods had no effect on prognosis.Early metastasis of incomplete resected lesions is a risk factor for prognosis of children with GCT. |
PDF Full Text Request