PURPOSE: Germ cell tumors (GCT) with somatic-type malignancy (SM) are rare occurring in approximately 2.7-8.6% of GCT cases.
Prognostic factors and optimal management remain poorly-defined.
PATIENTS AND METHODS: The Indiana University testis cancer database was queried from 1979 to 2011 for patients demonstrating GCT with SM at orchiectomy or subsequent resection. Patients with transformation to primitive neuroectodermal tumor only were excluded due to distinct management. Chart review, pathologic review, and survival analysis were performed.
RESULTS: 121 patients met study inclusion criteria. The most common SM histologies were sarcoma (59), carcinoma (31), and sarcomatoid yolk sac tumor (17). 32 patients demonstrated SM at GCT diagnosis. For those with delayed identification, median time from GCT to SM diagnosis was 33 months. This interval was longest for carcinomas (108 months). At a median follow-up of 71 months, the 5-year cancer specific survival (CSS) was 64%. Predictors of poorer CSS included SM diagnosed at late relapse (p = 0.017) referral to IU for reoperative retroperitoneal lymph node dissection (p = 0.026), and grade (p = 0.026). None of these factors maintained prognostic significance on multivariable analysis. SM histology subtype, stage, risk category, and number of resections were not predictive of CSS.
CONCLUSION: GCT with SM is associated with poorer CSS than traditional GCT. Established prognostic factors for GCT lose predictive value in the setting of SM. Aggressive and serial resections are often necessary to optimize CSS. Tumor grade is an important prognostic factor in sarcomas and sarcomatoid yolk sac tumors.
Written by:
Rice KR, Magers MJ, Beck SD, Cary KC, Einhorn LH, Ulbright TM, Foster RS. Are you the author?
Indiana University School of Medicine Department of Urology, Indianapolis, Indiana; Indiana University Melvin and Bren Simon Cancer Center, Indianapolis, Indiana; Indiana University School of Medicine Department of Pathology and Laboratory Medicine, Indianapolis, Indiana.
Reference: J Urol. 2014 Jun 18. pii: S0022-5347(14)03795-1.
doi: 10.1016/j.juro.2014.05.118
PubMed Abstract
PMID: 24952240
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