This national retrospective study demonstrated that stage, the use of chemotherapy and an elevated serum AFP level at diagnosis were independently predictive of OS. Additionally, female sex was associated with a significantly lower risk of death (HR 0.284; p-value 0.037), even after adjustment for tumour site and histology. The Malignant Germ Cell Tumour International Consortium (MaGIC) Study of 2015 reported that children with yolk sac tumours demonstrated a better outcome, although this was not found to be statistically significant. In addition age, and stage were significant predictors of outcome, but not sex (18).  A recent epidemiological study of paediatric germ cell tumours conducted in Danish children revealed a similar female predominance (71%) but did not show any relationship between sex and risk of death (25).