Real-world experience in the management of primary mediastinal germ cell tumour-resource-limited settings (PMGCT-RWE)

Objectives: Primary mediastinal germ cell tumours are rare malignancies with variable outcomes based on subtype, particularly with poorer outcomes in non-seminoma disease. Due to limited Real-world data in resource-limited settings, factors such as delayed presentation, treatment interruptions, limited access to multidisciplinary care, and higher treatment-related toxicity may significantly impact outcomes. Therefore, we aim to determine the real-world survival outcomes of these patients and to analyse their clinical presentation and treatment. Material and Methods: This retrospective cohort study reviewed electronic medical records of adult patients (>16 years) diagnosed with primary mediastinal germ cell tumours (PMGCTs) at Tata Memorial Hospital (TMH) and Advanced Centre for Treatment, Research, and Education in Cancer (ACTREC), Mumbai and Navi Mumbai, India, from January 2010 to June 2023. Data included baseline characteristics, tumour markers, treatment details (chemotherapy, surgery), and outcomes. Treatment response was assessed via Response Evaluation Criteria in Solid Tumours (RECIST 1.1 criteria), with survival analysis conducted using Kaplan-Meier methods. Results: A total of 101 patients diagnosed with PMGCT were identified from a prospectively maintained database; 6 patients with mature teratoma and 2 with incomplete records were excluded. Among 93 patients, 68 patients had primary mediastinal non-seminomatous germ cell tumours (PM-NSGCT), and 25 with seminoma were included for the retrospective analysis. Median age for PM-NGSCT was 30 years, and for seminoma was 37 years. Poor performance status (Eastern Cooperative Oncology Group [ECOG] >2) at presentation in PMNSGCT patients compared to that of primary mediastinal seminoma patients (56% vs 12%). Among the PMNSGCT cohort 44 (64.7%), patients underwent surgery post-induction chemotherapy. In these, out of 44 patients, 37 (82%) who had undergone surgery had R0 Resection. The 5-year and 8-year overall survival rates were 86% in primary mediastinal seminoma and 48% in PM-NSGCT patients. In PM-NSGCT patients, 22 deaths occurred, while 2 deaths occurred in the seminoma group. The median OS in the PM-NSGCT group was 45 months (95% CI: 23 months–not reached), with 5-year and 8-year OS overall survival rates of 49% (95% CI: 38–63%). In the seminoma group, the median OS was not reached. Conclusion: This is one of the largest retrospective data sets published in the PMGCT cohort in India with a median follow-up of 8 years. Aggressive management in terms of induction chemotherapy and surgery improved survival in the mediastinal PM-NSGCT population, even with limited access to transplant.