KẾT CỤC ĐIỀU TRỊ U TẾ BÀO MẦM ÁC TÍNH NGOÀI SỌ TẠI BỆNH VIỆN NHI ĐỒNG 2 VÀ CÁC YẾU TỐ LIÊN QUAN

Abstract

Background and aims: Germ cell tumors are a group of malignancies that originate in sex cells during development and migration. Tumors can originate from the genital tract such as testes, ovaries, or extra-genital such as intracranial, mediastinal, sacral, uterine, vaginal and account for 3.5% of all childhood cancers. under 15 years old. Treatment options for germ cell malignancies include surgery, chemotherapy, and radiation therapy, of which radiotherapy is avoided because of the long-term consequences of radiation exposure in children. This study aimed to describe the prognosis after at least 2 years of treatment of extra-cranial malignant germ cell tumors and associated factors. Methods: A prospective descriptive case series study in children all pediatric patients were diagnosed with extra-cranial malignant germ cell tumors at the Department of Hematology Oncology, Children's Hospital 2 from January 1, 2011 to July 31, 2019. Data were entered using REDCap software and analyzed using SPSS 20.0 software. Evaluation of treatment effectiveness through EFS and OS: using the Kaplan-Meier method to estimate the survival rate and compare it with the 2-way log-rank test method. A value of p < 0.05 was considered to be statistically significant. Results: We recorded 69 patients who met the sampling criteria, in which malignant germ cell tumors in the genital tract accounted for 69.6%. The mean total follow-up time was 53.3 months, the overall survival at 24 months and 60 months were both 92.5%; The 24-month and 60-month event-free survival rates were both 91%. The relapsed rate is 5.8%, the rate of treatment abandonment or non-adherence is 11.6%. The overall survival rate of germ cell tumors stage I-II is 100%, stage III-IV is 86.2%. The event-free survival rate for stage I-II malignant germ cell tumor stage I-II is 97%, stage III-IV is 86.2%. Factors associated with 5-year overall survival were risk stratification, tumor stage at diagnosis, AFP status > 10,000 kU/L, LDH status > 400 IU/L at diagnosis, and abandonment status. Factors associated with 5-year event-free survival were risk stratification, elevated LDH status at diagnosis, and tumor location. Conclusions: Malignant extra-cranial germ cell tumors in children have an excellent outcome with 92,5% 5-year OS and 91% 5-year EFS, equivalent to the results of treatment in the country and the region. Factors associated with poor 5-year OS were high risk stratification, stage III-IV at diagnosis, AFP > 10,000 kU/L, LDH > 400 IU/L at diagnosis, and abandonment status. Factors associated with poor 5-EFS survival were high risk stratification, LDH elevation > 400 IU/L and extra-gonadal tumors.