目的:很少有研究对生殖细胞肿瘤(GCT)的男性儿童和成人之间的组织学差异和生存意义进行量化。我们使用监测评估了这些差异以及与癌症特异性生存率(CSS)的关联,流行病学,和最终结果(SEER)癌症登记。
方法:SEER(1988-2016)用于鉴定诊断为精原细胞瘤和非精原细胞瘤GCT(NSGCT)的0至40岁男性患者。按年龄组(0-4,12-18,19-40岁)比较了人口统计学和肿瘤特征以及组织学分布。在多变量Cox比例风险回归模型中评估CSS。
结果:在确定的27,204名患者中,1,538(5.7%)为儿科(0-18岁)。Seminoma(54.3%)在成年患者(19-40岁)中占主导地位。在0到4岁之间,卵黄囊瘤(71.2%)和畸胎瘤(21.5%)最为常见。混合GCT(52.7%)在12至18岁精原细胞瘤中最普遍,胚胎,畸胎瘤的发生率分别为12%至15%。相对于儿科患者,在平均随访9年的Kaplan-Meier曲线上,成年患者精原细胞瘤的CSS相似,但NSGCT的CSS更差.绒毛膜癌和卵黄囊瘤相对于精原细胞瘤预后最差(分别为HR5.7和HR11.1,P<0.01)和成人(分别为HR4.6和HR4.6,两者P<0.01)针对阶段进行了调整。
结论:GCT的组织学因年龄而异,卵黄囊瘤和畸胎瘤在0至4岁的男性患者中占优势,混合GCT12到18年,和精原细胞瘤19到40年。患有NSGCT的儿科患者的CSS高于成人患者。在研究期间,混合GCT占GCT的比例越来越高。年龄,舞台,和组织学影响CSS在儿童和成人人群。
OBJECTIVE: Few studies have quantified differences in histology and implications for survival between male children and adults with germ cell tumors (GCT). We evaluated these differences and associations with cancer-specific survival (CSS) using Surveillance, Epidemiology, and End Results (SEER) cancer registries.
METHODS: SEER (1988-2016) was used to identify male patients 0 to 40 years of age diagnosed with seminoma and nonseminomatous GCT (NSGCT). Demographic and tumor characteristics were tabulated with histology distributions compared by age group (0-4, 12-18, 19-40 years old). CSS was evaluated in multivariable Cox proportional hazards regression models.
RESULTS: Among 27,204 patients identified, 1,538 (5.7%) were pediatric (0-18 years). Seminoma (54.3%) predominated in adult patients (ages 19-40). Among 0 to 4 years-old, yolk sac tumor (71.2%) and teratoma (21.5%) were most common. Mixed GCT (52.7%) was most prevalent among 12 to 18 years-old with seminoma, embryonal, and teratoma occurring in 12 to 15% each. Relative to pediatric patients, adult patients had similar CSS for seminoma but worse CSS for NSGCT on Kaplan-Meier curves with 9 years mean follow-up.
Choriocarcinoma and yolk sac tumors carried the worst prognosis relative to seminoma for both children (HR 5.7 and HR 11.1, respectively, both P < 0.01) and adults (HR 4.6 and HR 4.6, respectively, both P < 0.01) adjusted for stage.
CONCLUSIONS: Histology of GCTs vary by age with yolk sac tumors and teratoma predominating for male patients 0 to 4 years, mixed GCT for 12 to 18 years, and seminoma for 19 to 40 years. Pediatric patients with NSGCT had higher CSS than their adult counterparts. Mixed GCT represented an increasing proportion of GCT over the study period. Age, stage, and histology impact CSS in both pediatric and adult populations.