Neutrophil-To-Lymphocyte Ratio In Primary Mediastinal Germ Cell Tumors: A Retrospective Analysis Of > 20 Years Single Institution Experience

Objectives: To obtain information on outcome stratified by histology, extent and primary treatment patients' data with primary malignant mediastinal germ cell tumors treated between 1998 and 2018 were retrospectively analyzed.Methods: The primary treatment for localized malignant mediastinal germ cell tumors was neoadjuvant bleomycin+ etoposid + cisplatin (BEP) +/- surgery (n=22); or surgery +/- adjuvant BEP (n=16). For disseminated disease (n=21) first line BEP +/- second line chemotherapy were administered. For nonseminomas (NS) the NLR at start of BEP was analyzed in relation to disease-free survival (DFS), progression-free survival (PFS), and overall survival (OS).Results: After neoadjuvant treatment the 5-year DFS was 100% for seminomas (S), and 63.4% for NS. The 5-year OS was 100% for S, and 76.9% for NS. The 5-year DFS and OS after surgery +/- BEP for S was 72.9% and 100%, for NS was 75% and 87.5%, respectively. The 5-year PFS and OS of metastatic patients for S was 60% and 80%, while the median PFS and OS of NS were 5.7 and 11.1 months, respectively. Objective response (P=0.006) and low NLR (P= 0.043) were independent prognostic markers of longer OS.Conclusions: We confirmed the good outcome of BEP-treated S, while NS had poorer prognosis. Previously published prognostic models for NS were validated. Based on NLR and response a new prognostic model was developed. (C) 2020 The Authors. Published by Elsevier Inc.