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Outcomes of pediatric extracranial germ cell tumors: A single center experience in a developing country
Symbat Saliyeva1,2, Riza Boranbayeva1,2, Minira Bulegenova1,2
1Oncology/hematology Department, Scientific Center of Pediatrics and Pediatric Surgery, Almaty, Kazakhstan.
Insights
Extracranial germ cell tumors (GCT) in children can be effectively treated in developing countries using platinum-based chemotherapy. Key prognostic factors include disease stage, tumor site, and initial AFP levels, highlighting the importance of treatment adherence and specialist training.
Area of Science:
- Pediatric Oncology
- Oncologic Outcomes Research
- Global Health
Background:
- Extracranial germ cell tumors (GCT) represent a significant challenge in pediatric oncology, particularly in resource-limited settings.
- Understanding prognostic factors is crucial for optimizing treatment strategies and improving survival rates in children with GCT.
Purpose of the Study:
- To evaluate the outcomes of pediatric extracranial GCT in a developing country.
- To identify significant prognostic factors influencing survival in this patient cohort.
Main Methods:
- Retrospective analysis of 141 children (<18 years) with histopathologically confirmed extracranial GCT treated between February 2013 and June 2022.
- Standardized platinum-containing chemotherapy regimens were administered to all patients.
- Univariate and multivariate analyses were performed to identify prognostic factors.
Main Results:
- Overall survival (OS) and event-free survival (EFS) were 81.0% ± 4% and 73% ± 5% for malignant GCT, and 90% ± 5% and 85% ± 6% for teratoma.
- Significant prognostic factors identified included disease stage, tumor localization, initial AFP level (≥10,000 ng/mL), AFP kinetics, and resection status.
- Multivariate analysis indicated adverse prognostic factors such as resection status, initial AFP level ≥10,000 ng/mL, and slow AFP kinetics.
Conclusions:
- Good survival rates for pediatric extracranial GCT are achievable in developing countries with adherence to treatment protocols.
- Platinum-containing chemotherapy regimens demonstrate high efficacy.
- Implementation of high-income country protocols, supported by government funding and specialist training, is feasible in low-income countries.
Abstract:
The purpose of this study was to analyze the outcomes of extracranial GCT in children in a developing country and to assess prognostic factors. The data on 141 children (<18 years old) with extracranial GCT, confirmed histopathologically, collected over the past 9 years (from February 2013 to June 2022) were retrospectively studied. The patients underwent the same therapy with platinum-containing chemotherapy regimens. In the malignant GCT group, OS and EFS were 81.0 ± 4% and 73 ± 5%, respectively. OS and EFS in the teratoma group were 90 ± 5% and 85 ± 6%. In univariate analysis, parameters like stage of disease, tumor localization, AFP level ≥10,000 ng/mL, serum AFP kinetics and resection status were found to be statistically significant prognostic factors. In the multivariate analysis, the significant adverse factors were the resection status, initial AFP level ≥10,000 ng/mL and serum AFP kinetics slow down (p = .000). Good survival rates can be achieved in developing countries with adequate compliance with treatment protocols. The analysis demonstrates high efficacy of platinum-containing chemotherapy regimens. In our opinion, the protocol used in high-income countries can be implemented in low-income countries with the financial support from the government. The qualification of specialists is also important.
