Stage Ⅰ pediatric testicular germ cell tumors: An analysis of 41 cases

doi:10.19538/j.ek2017110610

Abstract：Objective To analyze the clinical characteristics and outcomes of children with stage Ⅰ testicular germ cell tumors (TGCT),and to discuss the treatment strategy for this disease after radical inguinal orchiectomy.Methods Clinical data of 41 patients with stage Ⅰ TGCT at Shanghai Children's Medical Center,Shanghai Jiaotong University School of Medicine between June 2003 to December 2013 were retrospectively analyzed.Their clinical characteristics,therapy and outcomes were analyzed.Results (1) The median age at diagnosis was 18 (3 to 43) months old.Among them,38 children(92.7％) were younger than 3 years old.The pathological subtype included 35 cases of yolk sac (85.4％),4 immature teratoma (9.7％) and 2 mixed germ cell tumors (4.9％).(2) Serum AFP levels were elevated in 38 patients (92.7％).AFP reduced to normal in 27 cases(71.1％)4 weeks after surgery and in 35 cases(92.1％) after 2 courses of chemotherapy respectively,but 2 cases of them relapsed with AFP increasing again.(3)Forty out of 41 patients underwent surgery and 3 ～ 4 courses of chemotherapy with cyclophosvnamide,vincristine and dactinomycin D (VAC).One patient received surgery alone.The median follow-up period was 64 months.One of the 32 patients who received adjuvant chemotherapy relapsed and then lost follow-up without treatment.The recurrence rate was 3.1％ and the 5-year overall survival was 100％.No complication related to chemotherapy occurred during the follow-up.The only one patient treated with surgery alone relapsed at 5 months and achieved complete response after salvage treatment.Conclusion (1) The relationship between the decrease of serum AFP and the prognosis is uncertain and needs to be further studied.(2) Short course chemotherapy with mild toxic side effects can reduce the recurrence rate effectively,so it can be used as a necessary treatment for patients with high risk of relapse,and it can also be used as a selective treatment for patients with low risk of recurrence.