ABSTRACT Objectives Limited data on metastatic germ cell tumors are available in Japan. We aimed to evaluate the long‐term cancer‐specific mortality of advanced germ cell tumors. Methods We present the clinical outcomes of 105 patients with mediastinal or metastatic germ cell tumors, including 33 seminoma and 72 non‐seminoma, who received induction cisplatin‐based chemotherapy at our hospital between September 2002 and February 2025. We evaluated the 5‐year cancer‐specific survival, pathologic findings of residual tumor resection, and risk factors for cancer death. Results The median follow‐up period of all patients was 63 months (interquartile range: 26–120 months). The 5‐year cancer‐specific survival was 97% in patients with seminoma and 73% in patients with non‐seminoma. Of 72 patients, 56 with non‐seminoma received residual tumor resection after chemotherapy. In terms of pathologic findings, the proportions of viable cells, teratoma, and necrosis were 25%, 30%, and 45%, respectively. The 5‐year cancer‐specific survival was 90% in 47 patients with normalized tumor markers at the time of surgery and 28% in nine patients with non‐normalized tumor markers. In multivariate analysis, non‐pulmonary visceral metastasis was the most significant risk factor associated with cancer‐related death. Conclusions The treatment of patients with non‐seminoma who present with non‐pulmonary visceral metastases, including metastases to the liver, brain, bone, and other visceral sites, remains challenging. Although patient selection is crucial, a subset of patients with non‐normalized tumor markers at the time of salvage surgery achieved long‐term survival.
Yamashita et al. (Fri,) studied this question.