title: Prognostic factors in children with extracranial malignant germ cell tumors: a monocentric pediatric Tunisian study.
abstract: Background Extracranial Germ cell tumors (GCT) are a rare and a heterogeneous group of pediatric cancers but highly curable. Aim We aimed to review management, outcome and prognostic factors that influence overall survival (OS) in a pediatric Tunisian oncologic unit. Methods We retrospectively evaluated between January 1998 and December 2012, 33 patients affected by extracranial germ cell tumors and treated according to TGM95 protocol established by the SFOPin a pediatric Tunisian oncologic unit. Results Patients had a mean age of 57 months (ranges: 1 day-13 years). There were 19 girls and 14 boys. Primary sites included 12 sacrococcygeal, 11 ovarian, 6 testicular, 3retro peritoneal and 1 mediastinal site. After a mean follow up of 26.1 months (ranges: 0-96 months), OSat 2 years and 5 years were respectively 82% and 75%. Event-free survival were respectively 79% at 2 years and 74% at 5 years. Various prognostic factors have been studied according to Kaplan-Meier. Univariate analyses identified significant factors which influence strongly OS: the stage (p=0.04), the completeness of surgery (p<0.001) and the relapse (p = 0, 0001). A multivariate study showed that only the quality of resection and the clinical stage remained strong significant prognostic factors (p=0,021) for 5-year OS. Conclusion Disease stage, completeness of surgery and relapse have been established as the most powerful prognostic parameter in our analysis. The improvement of survival of patients affected by extracranial germ cell tumors in Tunisia is a real achievement mainly due to the success of salvage treatments.
authors.forename: Faten
authors.initials: F
authors.lastname: Fedhila
authors.forename: Samar
authors.initials: S
authors.lastname: Rhayem
authors.forename: Habiba
authors.initials: H
authors.lastname: Hafsi
authors.forename: Wiem
authors.initials: W
authors.lastname: Douira
authors.forename: Raoudha
authors.initials: R
authors.lastname: Doghri
authors.forename: Monia
authors.initials: M
authors.lastname: Khemiri
authors.forename: Karima
authors.initials: K
authors.lastname: Mrad
authors.forename: Ibtissem
authors.initials: I
authors.lastname: Bellagha
authors.forename: Bechir
authors.initials: B
authors.lastname: Zouari
authors.forename: Sihem
authors.initials: S
authors.lastname: Barsaoui
mesh_terms: D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D018572:Disease-Free Survival; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D053208:Kaplan-Meier Estimate; D008297:Male; D015999:Multivariate Analysis; D009364:Neoplasm Recurrence, Local; D009367:Neoplasm Staging; D009373:Neoplasms, Germ Cell and Embryonal / Q000453:epidemiology / Q000473:pathology* / Q000601:surgery; D011379:Prognosis; D012189:Retrospective Studies; D016879:Salvage Therapy / Q000379:methods*; D015996:Survival Rate; D014416:Tunisia / Q000453:epidemiology