title: Malignant sacrococcygeal germ cell tumors in children: a 30-year experience from a single institution.
abstract: BACKGROUND
  Our aim was to analyze treatment results and survival characteristics of our patients with malignant sacrococcygeal germ cell tumors.
  
  
  METHODS
  Patient files of children with malignant sacrococcygeal germ cell tumors, treated at our institution between 1979 and 2009, were searched. Patient characteristics, histopathological subtypes, extension of disease, alpha-fetoprotein (AFP) level at the time of diagnosis and relapse, extent of surgical resection, chemotherapy protocols, details of radiotherapy and survival characteristics were recorded.
  
  
  RESULTS
  A total of 58 patients (M/F = 20/38) with malignant sacrococcygeal germ cell tumor was included in analysis. With a mean follow-up of 156 months (range, 26 days to 288.8 months) overall and event-free survival rates of the 58 patients were 50.9% and 43.8%, respectively. AFP status of the patients (37% in patients with <10,000 ng/ml, 68.9% in patients with ≥ 10,000 ng/ml), type of resection (total vs others), coccygeal resection, chemotherapy protocol (PEB vs others) and number of chemotherapy courses had an impact on event-free survival in univariate analysis. In multivariate analysis, AFP status had the greatest effect on prognosis.
  
  
  CONCLUSIONS
  Our treatment results are worse than those reported in the literature. Elevated AFP level at the time of diagnosis had a beneficial effect on prognosis, but year of diagnosis, tumor stage, presence of metastasis, tumor size and histopathological subtype had no impact on survival in patients with malignant sacrococcygeal germ cell tumors.
authors.affiliation: Institute of Oncology, Department of Pediatric Oncology, Hacettepe University, Ankara, Turkey.
authors.forename: Münevver
authors.initials: M
authors.lastname: Büyükpamukçu
authors.forename: Ali
authors.initials: A
authors.lastname: Varan
authors.forename: Serhan
authors.initials: S
authors.lastname: Küpeli
authors.forename: Saniye
authors.initials: S
authors.lastname: Ekinci
authors.forename: Sule
authors.initials: S
authors.lastname: Yalcin
authors.forename: Gülsev
authors.initials: G
authors.lastname: Kale
authors.forename: Bilgehan
authors.initials: B
authors.lastname: Yalçin
authors.forename: Tezer
authors.initials: T
authors.lastname: Kutluk
authors.forename: Canan
authors.initials: C
authors.lastname: Akyüz
mesh_terms: D000293:Adolescent; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000008:administration & dosage / Q000627:therapeutic use*; D014408:Biomarkers, Tumor / Q000378:metabolism*; D001761:Bleomycin / Q000008:administration & dosage; D016543:Central Nervous System Neoplasms / Q000556:secondary; D002648:Child; D002675:Child, Preschool; D002945:Cisplatin / Q000008:administration & dosage; D003520:Cyclophosphamide / Q000008:administration & dosage; D003609:Dactinomycin / Q000008:administration & dosage; D018572:Disease-Free Survival; D004334:Drug Administration Schedule; D018240:Endodermal Sinus Tumor / Q000175:diagnosis / Q000628:therapy; D005047:Etoposide / Q000008:administration & dosage; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007223:Infant; D007558:Italy / Q000453:epidemiology; D053208:Kaplan-Meier Estimate; D008175:Lung Neoplasms / Q000556:secondary; D008297:Male; D015999:Multivariate Analysis; D009364:Neoplasm Recurrence, Local / Q000175:diagnosis / Q000628:therapy; D009367:Neoplasm Staging; D009373:Neoplasms, Germ Cell and Embryonal / Q000378:metabolism / Q000401:mortality / Q000473:pathology* / Q000601:surgery / Q000628:therapy*; D012189:Retrospective Studies; D012445:Sacrococcygeal Region / Q000473:pathology / Q000601:surgery; D013724:Teratoma / Q000175:diagnosis / Q000628:therapy; D016896:Treatment Outcome; D014747:Vinblastine / Q000008:administration & dosage; D014750:Vincristine / Q000008:administration & dosage; D000509:alpha-Fetoproteins / Q000378:metabolism*
chemical_list: D014408:Biomarkers, Tumor; D000509:alpha-Fetoproteins; D001761:Bleomycin; D003609:Dactinomycin; D014750:Vincristine; D014747:Vinblastine; D005047:Etoposide; D003520:Cyclophosphamide; D002945:Cisplatin