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Incidence Patterns of Central Nervous System Germ Cell Tumors: A SEER Study

Goodwin, Tress L. MD*; Sainani, Kristin PhD; Fisher, Paul Graham MD

Journal of Pediatric Hematology/Oncology: August 2009 - Volume 31 - Issue 8 - p 541-544
doi: 10.1097/MPH.0b013e3181983af5
Original Articles

Background Incidence patterns of central nervous system (CNS) germ cell tumors (GCTs) have been reported, but the influence of underlying host risk factors has not been rigorously explored. We aimed to determine in a large, population-based cancer registry how age, sex, and race, influence the occurrence of CNS GCTs in the pediatric population.

Methods Using the Surveillance, Epidemiology, and End Results registry, we identified cases of histologically confirmed GCTs in children, adolescents, and young adults (age 0 to 29 y), diagnosed between 1973 and 2004. The cases were limited to only those with the International Classification of Childhood Cancer Xa: intracranial and intraspinal germ-cell tumors. Incidence rates (per 10,000) for each sex and race were plotted for single-age groups, and then stratified by tumor location and pathology subtype.

Results The sample included a total of 638 cases (490 males). Males had significantly higher rates of CNS GCTs than females. Male and female rates diverged significantly starting at the age of 11 years and remained widely discrepant until the age of 30 years. There were more germinomas than nongerminomas in both sexes. Germinomas peaked in incidence during adolescence, whereas nongerminoma incidence remained relatively constant in children and young adults. Tumor location differed strikingly by sex (P<0.0001) with pineal location more common in males (61.0% vs. 15.5%). Asian race was associated with a higher rate of CNS GCTs than other races.

Conclusions Males have higher incidence of CNS GCTs, primarily germinomas, than females, starting in the second decade. Pineal location is strongly associated with male sex, with pineal germinomas representing over half of all CNS GCTs in males. Asian-Americans have higher rates than other races. These findings suggest a robust but poorly understood influence of sex, either genetic or hormonal, and race on the occurrence of CNS GCTs.

*Stanford University School of Medicine

Departments of Health Research and Policy

Neurology, Pediatrics, and Neurosurgery, Stanford University School of Medicine, Stanford, CA

Reprints: Tress L. Goodwin, MD, Stanford Comprehensive Cancer Center, 875 Blake Wilbur Drive, Room CC2220, Stanford, CA 94305-5826 (e-mail:

Received for publication June 12, 2008; accepted November 17, 2008

© 2009 Lippincott Williams & Wilkins, Inc.