Prognostic factors in children with localized malignant nonseminomatous germ cell tumors

Purpose: Prognostic factors were studied in children older than 1 year who were treated with chemotherapy for extracranial localized malignant non sem inomatous germ cell tumors. Patients and Methods: Data from two consecutive protocols were pooled. The TGM 85 (1985-1989) protocol consisted of alternating courses of cyclophosph amide, dactinomycin and vinblastine, bleomycin, and cisplatin at a dose of 100 mg/m(2) per course. The TGM 90 (1990-1994) protocol war initiated with carboplatin 400 mg/m2 substituted for cisplatin as the only modification to the previous protocol. Results: We examined alpha-fetoprotein (AFP) levels, disease stage, and pri mary site and identified three prognostic groups, Patients with a poor prog nosis had either an AFP level greater than or equal to 10,000 ng/mL or stag e III disease and a sacrococcygeal or mediastinal primary site; such patien ts represented 46% of the patient population and experienced a 43% 3-year f ailure-free survival rate and a 77% overall survival rate. Patients with a good prognosis had an AFP level less than 10,000 ng/mL, stage I or II disea se, and a testicular, ovarian, perineal, or retroperitoneal primary site; s uch patients represented 22% of the patient papulation and experienced no t reatment failures. The other patients were classified in the intermediate p rognosis group and represented 37% of the patient population, with an 81% 3 -year failure-free survival rate and a 92% overall survival rate. Conclusion: Initial AFP level, disease stage, and primary site are the most important prognostic factors in this analysis. Prognostic models for pedia tric germ cell tumors should allow the stratification of patients for a ris k-adapted approach to treatment. (C) 1999 by American Society of Clinical O ncology.