{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,19]],"date-time":"2026-09-19T18:55:40Z","timestamp":1789844140261,"version":"4.0.1"},"reference-count":33,"publisher":"Wiley","issue":"7","license":[{"start":{"date-parts":[[2022,5,13]],"date-time":"2022-05-13T00:00:00Z","timestamp":1652400000000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Pediatric Blood &amp; Cancer"],"published-print":{"date-parts":[[2022,7]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>Background<\/jats:title><jats:p>The purpose of this single\u2010center study was to analyze the outcomes of extracranial germ cell tumors (GCTs) in children treated on a multimodality regimen.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>Retrospective study of children (&lt;18\u00a0years) with a histopathologically confirmed diagnosis of extracranial GCT over a period of 10\u00a0years (January 2009 to December 2018) treated on a uniform institution\u2010based protocol consisting of both cisplatin\u2010 and carboplatin\u2010based regimens. All completely excised teratomas and stage I gonadal tumors received no further therapy (low risk [LR]); stage IV ovarian, stage III\u2013IV extragonadal GCTs received six cycles of chemotherapy (high risk [HR]), and the remaining received four cycles of chemotherapy (intermediate risk [IR]).<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>A total of 297 children were treated with a female:male ratio of 1.72:1 and median age of 4\u00a0years. Forty\u2010three children had pure teratomas. Gonadal GCTs (<jats:italic>N<\/jats:italic>\u00a0=\u00a0180) were more common than extragonadal GCTs (<jats:italic>N<\/jats:italic>\u00a0=\u00a0117) with ovary as primary site in 128 children (43%) and sacrococcygeal site being the commonest extragonadal location (<jats:italic>N<\/jats:italic>\u00a0=\u00a041; 14%). LR, IR, and HR disease were noted in 60 (20.2%), 125 (42%), and 112 (37.8%) patients, respectively. Three\u2010fourths of ovarian tumors and half of testicular tumors operated prior to presentation needed upstaging. Forty\u2010one patients relapsed and 43 children expired (disease\u2010related: 33; toxic deaths: 9; unknown: 1). The 5\u2010year event\u2010free survival (EFS)\/overall survival (OS) of malignant GCT (<jats:italic>n<\/jats:italic>\u00a0=\u00a0254) was 72.50%\/82.70%, respectively, with gonadal site (<jats:italic>p<\/jats:italic>\u00a0=\u00a0.001), LR and IR (<jats:italic>p<\/jats:italic>\u00a0=\u00a0.001) and nonmetastatic disease (<jats:italic>p<\/jats:italic>\u00a0=\u00a0.001) being favorable prognostic variables.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>The LR and IR GCTs in our cohort had an excellent outcome. A significant proportion of IR gonadal GCTs can be spared of systemic chemotherapy by adhering to strict surgical guidelines. In HR GCTs however, intensifying therapies to improve outcomes must be balanced against the risk of cumulative toxicity, more so in a resource\u2010limited setting.<\/jats:p><\/jats:sec>","DOI":"10.1002\/pbc.29765","type":"journal-article","created":{"date-parts":[[2022,5,13]],"date-time":"2022-05-13T11:23:42Z","timestamp":1652441022000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":11,"title":["Outcomes and prognostic variables of extracranial germ cell tumors in children and adolescents treated over a decade: A developing world perspective"],"prefix":"10.1002","volume":"69","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-5299-2265","authenticated-orcid":false,"given":"Subramaniam","family":"Ramanathan","sequence":"first","affiliation":[{"name":"Department of Pediatric Oncology Tata Memorial Hospital  Mumbai Maharashtra 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