title: Factors associated with recurrence and metastasis in sacrococcygeal teratoma.
abstract: BACKGROUND
  Sacrococcygeal teratoma (SCT) is a relatively uncommon tumour, with a high risk of recurrence and metastasis. The factors associated with recurrence and metastatic disease were studied.
  
  
  METHODS
  A retrospective review was conducted of 173 children with SCT treated between January 1970 and February 2003 at the paediatric surgical centres in the Netherlands. Risk factors were identified by univariate and multivariate analysis.
  
  
  RESULTS
  Eight children died shortly after birth or around the time of operation. Nine children, all over 18 months old, had metastases at presentation. Four teratomas with metastasis showed mature histology of the primary tumour. Nineteen children had recurrence of SCT a median interval of 10 months (range 32 days to 35 months) after primary surgery. Risk factors for recurrence were pathologically confirmed incomplete resection (odds ratio (OR) 6.54 (95 per cent confidence interval (c.i.) 2.11 to 20.31)), immature histology (OR 5.74 (95 per cent c.i. 1.49 to 22.05)) and malignant histology (OR 12.83 (95 per cent c.i. 3.27 to 50.43)). Size, Altman classification, age and decade of diagnosis were not risk factors for recurrence. One-third of the recurrences showed a shift towards histological immaturity or malignancy, compared with the primary tumour. Seven patients died after recurrence, five with malignant disease.
  
  
  CONCLUSIONS
  This national study showed that SCT recurred in 11 per cent of the children within 3 years of operation. Risk factors were immature and malignant histology, or incomplete resection. Mature teratoma has the biological capability to become malignant.
authors.affiliation: Department of Surgery, University Hospital, Maastricht, The Netherlands.
authors.forename: J P M
authors.initials: JP
authors.lastname: Derikx
authors.forename: A
authors.initials: A
authors.lastname: De Backer
authors.forename: L
authors.initials: L
authors.lastname: van de Schoot
authors.forename: D C
authors.initials: DC
authors.lastname: Aronson
authors.forename: Z J
authors.initials: ZJ
authors.lastname: de Langen
authors.forename: T L
authors.initials: TL
authors.lastname: van den Hoonaard
authors.forename: N M A
authors.initials: NM
authors.lastname: Bax
authors.forename: F
authors.initials: F
authors.lastname: van der Staak
authors.forename: L W E
authors.initials: LW
authors.lastname: van Heurn
mesh_terms: D004812:Epidemiologic Methods; D005260:Female; D006801:Humans; D007231:Infant, Newborn; D008297:Male; D009364:Neoplasm Recurrence, Local / Q000401:mortality / Q000473:pathology*; D009426:Netherlands / Q000453:epidemiology; D012445:Sacrococcygeal Region; D013125:Spinal Neoplasms / Q000401:mortality / Q000473:pathology* / Q000601:surgery; D013724:Teratoma / Q000401:mortality / Q000473:pathology* / Q000601:surgery; D016896:Treatment Outcome