title: Hematologic disorders associated with primary mediastinal nonseminomatous germ cell tumors.
abstract: BACKGROUND
  The association between primary germ cell tumors of the mediastinum (the space between the lung pleura that contains the heart and other chest viscera) and hematologic malignancies has been described by retrospective analysis of patients treated at individual clinical centers. To better characterize the risk of hematologic disorders in patients with extragonadal germ cell tumors and to describe the clinical and biologic features of the disorders, we studied an unselected population in a large, international, multicenter database.
  
  
  METHODS
  Six hundred thirty-five patients treated at 11 centers in the United States and Europe from 1975 through 1996 were evaluated retrospectively.
  
  
  RESULTS
  A hematologic disorder was observed in 17 patients with germ cell tumors. All cases developed among the 287 patients with primary mediastinal nonseminomatous germ cell tumors, giving an incidence rate in this group of 2.0% (95% confidence interval [CI] = 1.1%-3.1%) per year over a median follow-up time of 3 years. The risk of developing hematologic disorders was statistically significantly increased in patients with primary mediastinal nonseminomatous germ cell tumors in comparison with the age-matched general population (standardized incidence ratio = 250; 95% CI = 140-405). The median time to onset of hematologic neoplasia was 6 months (range, 0-47 months), and the median survival after diagnosis of the hematologic disorder was 5 months (range, 0-16 months) (two-sided P<.0001, comparing survival from the time of diagnosis of the germ cell tumor of patients with and without hematologic disorders).
  
  
  CONCLUSIONS
  In our study, approximately one in 17 patients with primary mediastinal nonseminomatous germ cell tumors was affected by a hematologic disorder, whereas no cases were seen among 334 patients with other extragonadal germ cell tumors. The hematologic disorder had a statistically significant impact on prognosis, with none of the 17 reported patients surviving for more than 2 years.
authors.affiliation: Tuebingen University Medical Center II, Germany.
authors.forename: J T
authors.initials: JT
authors.lastname: Hartmann
authors.forename: C R
authors.initials: CR
authors.lastname: Nichols
authors.forename: J P
authors.initials: JP
authors.lastname: Droz
authors.forename: A
authors.initials: A
authors.lastname: Horwich
authors.forename: A
authors.initials: A
authors.lastname: Gerl
authors.forename: S D
authors.initials: SD
authors.lastname: Fossa
authors.forename: J
authors.initials: J
authors.lastname: Beyer
authors.forename: J
authors.initials: J
authors.lastname: Pont
authors.forename: K
authors.initials: K
authors.lastname: Fizazi
authors.forename: L
authors.initials: L
authors.lastname: Einhorn
authors.forename: L
authors.initials: L
authors.lastname: Kanz
authors.forename: C
authors.initials: C
authors.lastname: Bokemeyer
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D018240:Endodermal Sinus Tumor / Q000150:complications; D005060:Europe; D005260:Female; D018237:Germinoma / Q000150:complications* / Q000175:diagnosis / Q000628:therapy; D006402:Hematologic Diseases / Q000209:etiology*; D006801:Humans; D008297:Male; D008479:Mediastinal Neoplasms / Q000150:complications* / Q000175:diagnosis / Q000628:therapy; D008875:Middle Aged; D011379:Prognosis; D012189:Retrospective Studies; D016019:Survival Analysis; D018243:Teratocarcinoma / Q000150:complications; D014481:United States