{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,26]],"date-time":"2026-06-26T05:47:52Z","timestamp":1782452872654,"version":"3.54.5"},"reference-count":22,"publisher":"Wiley","issue":"6","license":[{"start":{"date-parts":[[2026,5,29]],"date-time":"2026-05-29T00:00:00Z","timestamp":1780012800000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"},{"start":{"date-parts":[[2026,5,29]],"date-time":"2026-05-29T00:00:00Z","timestamp":1780012800000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Int J of Urology"],"published-print":{"date-parts":[[2026,6]]},"abstract":"<jats:title>ABSTRACT<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Objectives<\/jats:title>\n                    <jats:p>Limited data on metastatic germ cell tumors are available in Japan. We aimed to evaluate the long\u2010term cancer\u2010specific mortality of advanced germ cell tumors.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>We present the clinical outcomes of 105 patients with mediastinal or metastatic germ cell tumors, including 33 seminoma and 72 non\u2010seminoma, who received induction cisplatin\u2010based chemotherapy at our hospital between September 2002 and February 2025. We evaluated the 5\u2010year cancer\u2010specific survival, pathologic findings of residual tumor resection, and risk factors for cancer death.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>The median follow\u2010up period of all patients was 63\u2009months (interquartile range: 26\u2013120\u2009months). The 5\u2010year cancer\u2010specific survival was 97% in patients with seminoma and 73% in patients with non\u2010seminoma. Of 72 patients, 56 with non\u2010seminoma 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\u2010year cancer\u2010specific survival was 90% in 47 patients with normalized tumor markers at the time of surgery and 28% in nine patients with non\u2010normalized tumor markers. In multivariate analysis, non\u2010pulmonary visceral metastasis was the most significant risk factor associated with cancer\u2010related death.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>The treatment of patients with non\u2010seminoma who present with non\u2010pulmonary 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\u2010normalized tumor markers at the time of salvage surgery achieved long\u2010term survival.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1111\/iju.70531","type":"journal-article","created":{"date-parts":[[2026,5,29]],"date-time":"2026-05-29T12:45:12Z","timestamp":1780058712000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Long\u2010Term Clinical Outcomes of Advanced Germ Cell Tumors: Experience From 105 Patients Over 20\u2009Years"],"prefix":"10.1111","volume":"33","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-4131-1185","authenticated-orcid":false,"given":"Ryo","family":"Yamashita","sequence":"first","affiliation":[{"name":"Division of Urology Shizuoka Cancer Center  Suntougun Shizuoka Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0006-7108-7811","authenticated-orcid":false,"given":"Yuma","family":"Sakura","sequence":"additional","affiliation":[{"name":"Division of Urology Shizuoka Cancer Center  Suntougun Shizuoka Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Takashi","family":"Sugino","sequence":"additional","affiliation":[{"name":"Division of Pathology Shizuoka Cancer Center  Suntougun Shizuoka Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0863-9223","authenticated-orcid":false,"given":"Akifumi","family":"Notsu","sequence":"additional","affiliation":[{"name":"Clinical Research Center Shizuoka Cancer Center  Suntougun Shizuoka Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tomomasa","family":"Matsuo","sequence":"additional","affiliation":[{"name":"Division of Urology Shizuoka Cancer Center  Suntougun Shizuoka Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yutaro","family":"Hayashi","sequence":"additional","affiliation":[{"name":"Division of Urology Shizuoka Cancer Center  Suntougun Shizuoka Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0001-6983-2214","authenticated-orcid":false,"given":"Kana","family":"Ito","sequence":"additional","affiliation":[{"name":"Division of Urology Shizuoka Cancer Center  Suntougun Shizuoka Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hideo","family":"Shinsaka","sequence":"additional","affiliation":[{"name":"Division of Urology Shizuoka Cancer Center  Suntougun Shizuoka Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Masafumi","family":"Nakamura","sequence":"additional","affiliation":[{"name":"Division of Urology Shizuoka Cancer Center  Suntougun Shizuoka Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Masato","family":"Matsuzaki","sequence":"additional","affiliation":[{"name":"Division of Urology Shizuoka Cancer Center  Suntougun Shizuoka Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Masashi","family":"Niwakawa","sequence":"additional","affiliation":[{"name":"Division of Urology Shizuoka Cancer Center  Suntougun Shizuoka Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2026,5,29]]},"reference":[{"key":"e_1_2_12_2_1","doi-asserted-by":"publisher","DOI":"10.1200\/JCO.20.03296"},{"key":"e_1_2_12_3_1","doi-asserted-by":"publisher","DOI":"10.1001\/jama.2024.27122"},{"key":"e_1_2_12_4_1","doi-asserted-by":"publisher","DOI":"10.1097\/SLA.0000000000003754"},{"key":"e_1_2_12_5_1","doi-asserted-by":"publisher","DOI":"10.1007\/s10147-024-02607-y"},{"key":"e_1_2_12_6_1","doi-asserted-by":"publisher","DOI":"10.1200\/JCO.2015.62.7000"},{"key":"e_1_2_12_7_1","doi-asserted-by":"publisher","DOI":"10.1093\/annonc\/mdw648"},{"key":"e_1_2_12_8_1","doi-asserted-by":"publisher","DOI":"10.1111\/iju.12760"},{"key":"e_1_2_12_9_1","doi-asserted-by":"publisher","DOI":"10.1111\/iju.12844"},{"key":"e_1_2_12_10_1","doi-asserted-by":"publisher","DOI":"10.1093\/jjco\/hyac151"},{"key":"e_1_2_12_11_1","doi-asserted-by":"publisher","DOI":"10.1111\/iju.70118"},{"key":"e_1_2_12_12_1","unstructured":"European Association of Urology \u201cEAU Guidelines on Testicular Cancer. 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