NEW YORK (Reuters Health) Dec 24 - While yolk sac tumors remain an aggressive form of germ cell cancers with a relatively poor prognosis, the 5-year survival rate has improved significantly over the past decade, particularly in younger patients.
In a study published in the December 1 issue of the International Journal of Cancer, Dr. Jay P. Shah and colleagues at Wayne State University in Detroit, Michigan, compared patient characteristics and survival rates in males and females with yolk sac tumors.
The investigators used the Surveillance, Epidemiology, and End Results (SEER) Program database from 1973 through 2003 to extract demographic and clinicopathologic information on 788 patients, 451 males and 337 females, with yolk sac tumors.
Median age was 23 years for males and 19 years for females; 22 years for whites and 18 years for African-Americans.
There was a bimodal distribution for age at diagnosis, with an increased incidence in the first four years of life and again at age 10-30 years. "The bimodal age distribution of yolk sac tumors generates the hypothesis that sex steroids may play a role in selected yolk sac tumors," Dr. Shah believes.
Most primary tumors were gonadal in origin, with the testis the primary site in 42.6% of tumors and the ovaries the primary site in 32.6%. One-fourth (24.6%) of yolk sac tumors were extragonadal in origin.
Males with extragonadal tumors had the shortest 5-year survival rates while males with testicular yolk sac tumors had the longest 5-year survival rates compared with females with either ovarian or extragonadal tumors.
Among extragonadal tumors, site of origin differed in males and females. The mediastinum and retroperitoneum were more common in males, while tumors of the heart and soft tissues were more common in females.
The median survival for the cohort overall was 87 months and was similar in males and females. The 5-year survival of extragonadal yolk sac tumors was 66%, while it was 86% for gonadal tumors. African-Americans had the worst survival, overall.
Survival of both males and females with yolk sac tumors steadily improved from 1973 through 2003. Although the overall survival in all yolk sac tumor patients has improved, the primary sites of origin remain different in males and females and affect prognosis.
"In general, the epidemiological patterns reveal that pediatric onset (patients) seem to do better then adult onset," Dr. Shah commented in an interview with Reuters Health.
"Yolk sac tumors remain an aggressive form of germ cell cancers, but the application of chemotherapy has significantly improved survival over the past few decades," he said. "Both male and female patients should be aggressively treated."
Int J Cancer 2008;123:2671-2675.
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