Long-term survival and prognostic factors in extragonadal germ cell tumors: a 30-year experience at a single institution.

PURPOSE: Extragonadal germ cell tumors (EGCT) are rare malignancies, typically located in midline structures, with treatment consisting of cisplatin-based chemotherapy. We aimed to evaluate long-term outcomes, identify prognostic factors and assess treatment efficacy.

METHODS

We retrospectively evaluated 31 patients with EGCT between 1994 and 2024. RStudio was used for data analysis. Progression free survival (PFS) and overall survival (OS) was assessed using Kaplan-Meier, and prognostic factors via Cox regression. Approval was obtained from our local Ethics Committee.

RESULTS

The most common site was mediastinum (59%), followed by retroperitoneum and central nervous system. Non-seminomatous germ cell tumors (NSGCT) were more frequent than seminomas (61% vs. 39%), and 41% of patients had metastasis at diagnosis. After first-line chemotherapy plus selective surgery or irradiation, the disease control rate was 81%. Progression or relapse occurred in 48% of patients, mostly in those with mediastinal NSGCT. No secondary malignancies were detected during follow-up. 5- and 10-year OS were 70%. NSGCT histology and mediastinal location were significantly associated with lower survival, with a 5-year OS of 34% in mediastinal NSGCT.

CONCLUSIONS

While cisplatin-based chemotherapy remains effective for EGCT patients, mediastinal NSGCT pose significant challenges, highlighting the need for improved strategies.