{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,20]],"date-time":"2026-09-20T14:39:02Z","timestamp":1789915142427,"version":"4.0.1"},"reference-count":26,"publisher":"Wiley","issue":"2","license":[{"start":{"date-parts":[[2012,6,12]],"date-time":"2012-06-12T00:00:00Z","timestamp":1339459200000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"funder":[{"name":"Federal Ministry for Education and Research, Bonn"},{"name":"Deutsche Krebshilfe e.V., Bonn, Germany"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Pediatric Blood &amp; Cancer"],"published-print":{"date-parts":[[2013,2]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>Background<\/jats:title><jats:p>The overall risk for brain metastases among children and adolescents with extracranial malignant germ cell tumors (mGCT) is low but may vary between subgroups. Early identification of subgroups with an increased risk for brain metastasis is therefore important.<\/jats:p><\/jats:sec><jats:sec><jats:title>Procedure<\/jats:title><jats:p>We analyzed 900\/2,160 patients from the German MAHO\/MAKEI registry on children and adolescents with malignant extracranial GCT (pure teratomas (grade 0\u20133) were not included). For follow\u2010up evaluation, patients with brain metastases at diagnosis and those with a follow\u2010up shorter than 32 months after diagnosis (longest interval to brain metastases in our cohort) were excluded. Patients were censored at detection of brain metastases or death due to other causes. A decision tree analysis considering age, gender, site of primary tumor, and presence of other metastases at diagnosis as risk factors for brain metastases was performed.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>Among 838 eligible patients, 9 acquired brain metastases during follow\u2010up, accounting for death in 5. There were no brain metastases in absence of extracranial metastases at diagnosis. If extracranial metastases were detected in absence of mediastinal mGCT the risk for brain metastases was 1.2% (95% CI: 0.2\u20133.5.%). In contrast, risk was increased to 37.5 (95% CI 15.2\u201364.6%) in patients with mediastinal GCTs and extracranial metastases.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion<\/jats:title><jats:p>A high\u2010risk subgroup is detected with a decision tree analysis approach. These patients may benefit from an intensified chemotherapy. Close surveillance for CNS\u2010metastases is warranted in this high\u2010risk group while less close monitoring in low\u2010risk patients is justified. Pediatr Blood Cancer 2013;60:217\u2013223. \u00a9 2012 Wiley Periodicals, Inc.<\/jats:p><\/jats:sec>","DOI":"10.1002\/pbc.24229","type":"journal-article","created":{"date-parts":[[2012,6,12]],"date-time":"2012-06-12T14:45:27Z","timestamp":1339512327000},"page":"217-223","source":"Crossref","is-referenced-by-count":9,"title":["Brain metastases during follow\u2010up of children and adolescents with extracranial malignant germ cell tumors: Risk adapted management decision tree analysis based on data of the MAHO\/MAKEI\u2010registry"],"prefix":"10.1002","volume":"60","author":[{"given":"Ulrich","family":"G\u00f6bel","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"R\u00fcdiger","family":"von Kries","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Carmen","family":"Teske","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Dominik T.","family":"Schneider","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Andreas","family":"Beyerlein","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Benedikt","family":"Bernbeck","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Gabriele","family":"Calaminus","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2012,6,12]]},"reference":[{"key":"e_1_2_7_2_2","doi-asserted-by":"publisher","DOI":"10.1093\/neuonc\/nor014"},{"key":"e_1_2_7_3_2","doi-asserted-by":"publisher","DOI":"10.1055\/s-0028-1086027"},{"key":"e_1_2_7_4_2","doi-asserted-by":"publisher","DOI":"10.1200\/JCO.2003.03.125"},{"key":"e_1_2_7_5_2","doi-asserted-by":"publisher","DOI":"10.1002\/(SICI)1098-2264(199906)25:2<134::AID-GCC9>3.0.CO;2-Y"},{"key":"e_1_2_7_6_2","doi-asserted-by":"publisher","DOI":"10.3109\/15513819409023342"},{"key":"e_1_2_7_7_2","doi-asserted-by":"publisher","DOI":"10.1002\/gcc.10053"},{"key":"e_1_2_7_8_2","doi-asserted-by":"publisher","DOI":"10.1002\/gcc.20363"},{"key":"e_1_2_7_9_2","doi-asserted-by":"publisher","DOI":"10.1038\/nrc1568"},{"key":"e_1_2_7_10_2","doi-asserted-by":"publisher","DOI":"10.1002\/cncr.20411"},{"key":"e_1_2_7_11_2","doi-asserted-by":"publisher","DOI":"10.1055\/s-0030-1249661"},{"key":"e_1_2_7_12_2","doi-asserted-by":"publisher","DOI":"10.1023\/A:1008360523160"},{"key":"e_1_2_7_13_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.hoc.2011.03.012"},{"key":"e_1_2_7_14_2","doi-asserted-by":"publisher","DOI":"10.1097\/AOG.0b013e3181d44053"},{"key":"e_1_2_7_15_2","doi-asserted-by":"publisher","DOI":"10.1016\/S0022-5347(05)00353-8"},{"key":"e_1_2_7_16_2","doi-asserted-by":"publisher","DOI":"10.1055\/s-2008-1034068"},{"key":"e_1_2_7_17_2","doi-asserted-by":"publisher","DOI":"10.1055\/s-2008-1034069"},{"key":"e_1_2_7_18_2","doi-asserted-by":"publisher","DOI":"10.1200\/JCO.2003.09.035"},{"key":"e_1_2_7_19_2","unstructured":"AtkinsonE TherneauT.An introduction to recursive partitioning using rpart routines. 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