Factors Associated with Survival in Pediatric Extracranial Germ Cell Tumors: A Study Focusing on Postoperative Alpha-Fetoprotein

Tiyaamornwong, Sasabong; Vichitkunakorn, Polathep; Sripornsawan, Pornpun; Choochuen, Pongsakorn; Pongpanit, Chayut; Sirichamratsakul, Kulpreeya; Sangkhathat, Surasak

doi:10.31557/APJCP.2025.26.7.2489

Factors Associated with Survival in Pediatric Extracranial Germ Cell Tumors: A Study Focusing on Postoperative Alpha-Fetoprotein

Document Type : Research Articles

Authors

¹ Department of pediatric surgery, Faculty of Prince of Songkla university, Thailand.

² Department of Surgery, Faculty of Medicine, Prince of Songkla University, Hatyai, Songkla, Thailand.

³ Division of Pediatric Oncology, Faculty of Medicine, Prince of Songkla University, Hatyai, Songkla, Thailand.

⁴ Department of Biomedical sciences, Faculty of Medicine, Prince of Songkla University, Thailand.

⁵ Division of Gynecologic Oncology Unit Department of Obstetrics and Gynecology Faculty of Medicine, Prince of Songkla University Hat Yai, Songkla, Thailand.

10.31557/APJCP.2025.26.7.2489

Abstract

Background: Alpha-fetoprotein (AFP) is commonly used in the management of pediatric extracranial germ cell tumors (eGCT), but its prognostic role remains unclear. We investigated survival outcomes and the impact of serial AFP changes after surgery. Method: We analyzed data from 129 pediatric eGCT patients (age 0-15) who underwent surgery at our institution. We evaluated overall survival (OS) and recurrence-free survival (RFS). in non-benign eGCTs, serial AFP measurements were performed postoperatively. Results: OS and RFS were 87.4% and 82.6%, respectively. Poorer survival was associated with male sex, non-sacrococcygeal extragonadal site, yolk sac tumor/choriocarcinoma histology, initial AFP > 50,000 ng/mL, and operative complications. Postoperative log-AFP values showed significant differences between long-term survivors and non-survivors from one month onwards. AFP normalization (<100 ng/mL) at one month was associated with improved 5-year OS (93.4% vs. 69.4%, p=0.031). Conclusion: Serial AFP measurement from one month post-surgery has prognostic value in pediatric eGCT. Patients who fail to normalize AFP should be closely monitored for recurrence.

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