Presence of Teratoma and Disease-Related Death in Advanced Germ Cell Tumors


Key Points

  • Teratoma in NSGCT was associated with a higher risk of disease-related death.
  • Mature teratoma was associated with a higher risk vs immature teratoma.  

In a single-center retrospective analysis reported in the Journal of Clinical Oncology, Funt et al found that the presence of teratoma in advanced nonseminomatous germ cell tumors was associated with a greater risk for disease-related death.

The study was a retrospective review of primary tumor specimens obtained between April 1975 and May 1996 from patients with germ cell tumors who received modern-dose first-line platinum-based chemotherapy at Memorial Sloan Kettering Cancer Center in New York. The cumulative incidence of disease-related death (CIDD) was the primary outcome measure.

Impact of Teratoma

Tumors were available from 232 patients, including 193 with nonseminomatous germ cell tumors. At least one component of teratoma was identified in 82 nonseminomatous germ cell primary tumors (42%).

During a median follow-up of 17 years (range = 0.3–35 years), 58 patients with nonseminomatous germ cell tumors died, 47 as a result of germ cell tumors and 11 as a result of other causes. Most deaths due to germ cell tumors occurred within the first 5 years and were associated with pretreatment risk status (P < .001). The incidence of death due to other causes increased after 15 years and was not associated with pretreatment risk status.

The CIDD at 5 years was highest among patients who had NSGCT with teratoma vs those with nonseminomatous germ cell tumors without teratoma and those with seminoma (5-year CIDD = 27.4%, 17.4%, and 10.3%, respectively; P = .03). A higher 5-year CIDD was found in patients who had nonseminomatous germ cell tumors with mature teratoma (n = 42) vs those with either nonseminomatous germ cell tumors with immature teratoma (n = 29) or nonseminomatous germ cell tumors without teratoma (38.1%, 19.9%, and 17.4%, respectively; P = .01).

The investigators concluded, “The presence of teratoma, particularly mature teratoma, in [a nonseminomatous germ cell] primary tumor is associated with a higher CIDD, consistent with the hypothesis that differentiation is associated with adverse outcomes. Death as a result of non-[germ cell tumor] causes is not associated with risk status and must be separated from [germ cell tumor] death when evaluating long-term survival.”

Samuel A. Funt, MD, of the Genitourinary Oncology Service, Memorial Sloan Kettering Cancer Center, is the corresponding author for the Journal of Clinical Oncology article.  

Disclosure: The study was supported by the National Cancer Institute and the Byrne Fund. For full disclosures of the study authors, visit

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