Prognostic factors and outcomes of nonseminomatous germ cell tumours of testis—experience from a tertiary cancer centre in India (original) (raw)
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Predictors of outcome in patients with advanced nonseminomatous germ cell testicular tumors
2014
Background: Predictor factors determining complete response to treatment are still not clearly defined. We aimed to evaluate clinicopathological features, risk factors, treatment responses, and survival analysis of patient with advanced nonseminomatous GCTs (NSGCTs). Materials and Methods: Between November 1999 and September 2011, 140 patients with stage II and III NSGCTs were referred to our institutions and 125 patients with complete clinical data were included in this retrospective study. Four cycles of BEP regimen were applied as a first-line treatment. Salvage chemotherapy and/or high-dose chemotherapy (HDCT) with autologous stem cell transplantation were given in patients who progressed after BEP chemotherapy. Post-chemotherapy surgery was performed in selected patients with incomplete radiographic response and normal tumor markers. Results: The median age was 28 years. For the good, intermediate and poor risk groups, compete response rates (CRR) were, 84.6%, 67.9% and 59.4%, respectively. Extragonadal tumors, stage 3 disease, intermediate and poor risk factors, rete testis invasion were associated with worse outcomes. There were 32 patients (25.6%) with non-CR who were treated with salvage treatment. Thirty-one patients died from GCTs and 94% of them had stage III disease. Conclusions: Even though response rates are high, some patients with GCTs still need salvage treatment and cure cannot be achieved. Non-complete response to platinium-based first-line treatment is a negative prognostic factor. Our study confirmed the need for a prognostic and predictive model and more effective salvage approaches.
Clinical Genitourinary Cancer, 2015
Primary mediastinal nonseminomatous germ cell tumors comprise a heterogeneous series of neoplasms characterized by limited chemosensitivity and a poor prognosis. We analyzed a large series of patients from our tertiary cancer center, including pre-and postsurgical variables, with the aim to provide a prognostic model that might be suitable for clinical use. The variables identified in the prognostic model were surgical removal of residuals after first-line chemotherapy, histological response, and the presence of lung metastases. Their joint analysis defined distinct overall survival (OS) curves. Background: Primary mediastinal germ cell tumors (PMGCTs) poorly benefit from chemotherapy and half of patients die because of disease progression. Enhancing the risk stratification might result in tailoring a more personalized treatment strategy from the time of diagnosis. Patients and Methods: Between the years 1985 and 2012, 86 patients with PMGCT were treated at our center. Cox proportional hazards regression analysis was conducted in the population of nonseminomas to examine the prognostic effect of candidate factors on progression-free and OS. OS curves were compared using the KaplaneMeier method and the log-rank test. Results: Mean age was 29.8 years (range, 15-63 years). Twenty-five patients (29.1%) had lung and 8 (9.3%) liver, bone, or brain metastases. Twelve patients (13.9%) received upfront high-dose chemotherapy and 45 patients (52.3%) underwent surgery after chemotherapy. Cox analyses included 61 evaluable primary mediastinal nonseminomatous germ cell tumors (PMNSGCTs). The final model of factors indicating a poor prognosis included the combination of surgery and histological response (overall P ¼ .011) and lung metastases (hazard ratio, 3.03; 95% confidence interval, 1.12-8.15; P ¼ .028). The model showed a bootstrap-corrected Harrel c-statistic for OS of 0.66. A risk stratification model based on the combination of these factors and accounting for a 50% 5-year survival cutoff identified 2 groups (poor prognosis, n ¼ 33 vs. good prognosis, n ¼ 28) with distinct OS curves (P < .001). Preoperative serum tumor marker level was not associated with
Clinical Oncology, 2004
Aims: The survival of germ-cell tumours (GCT) was transformed after the introduction of cisplatin-based therapy. Previous trials have indicated BEP (bleomycin, etoposide and cisplatin) as the optimum treatment, although some centres including our own advocate the use of the alternating regimen POMB-ACE (cisplatin, vincristine, methotrexate, bleomycin and dactinomycin, cyclophosphamide and etoposide) for men with intermediate or poor prognosis disease. We analysed the survival and management of GCT patients treated at a specialist cancer centre in relation to internationally recognised prognostic groupings. Materials and methods: We retrieved patient information using the Trent Testicular Tumour Registry and supplemented it with information from patient notes. This included all patients with Royal Marsden Hospital Stage II, III and IV disease and patients with stage I disease at diagnosis with raised markers or subsequent relapse. We compared the efficacy and toxicity of the BEP and POMB-ACE chemotherapy regimens, and assessed relapse-free and overall survival. Results: We identified 178 non-seminomatous germ cell tumours (NSGCT) and 71 seminoma patients. Overall survival was similar to the International Germ Cell Cancer Collaborative Group (IGCCCG) classification for the good (95% vs 92%) and intermediate groups (82% vs 80%). The outcome for the poor prognosis group was better than expected in our series (57% vs 48%). There was a higher proportion of both immediate and late side-effects with POMB-ACE. Conclusion: Survival and disease progression rates at this single institution were at least as good as reported by the IGCCCG and somewhat better for the poor-prognosis group. This may reflect use of the POMB-ACE chemotherapy regimen as opposed to standard BEP regimen. However, a randomised comparison of BEP and POMB-ACE would be required to validate this. Bhala N.
Clinical Genitourinary Cancer, 2019
In contemporary stage I nonseminoma germ-cell tumor of the testis (NSGCTT) patients, increasing use of surveillance and chemotherapy, in concordance with guideline recommendations, is evident. Long-term survival rates were comparable between surveillance and active treatment (AT) patients. Among AT, retroperitoneal lymph node dissection was associated with better long-term survival outcomes. These results confirm the contemporary adherence to guideline recommendations and also confirm the safety of surveillance in patients with stage I NSGCTT. Background: Historical data demonstrated similar survival outcomes in patients with stage I nonseminoma germ-cell tumor of the testis (NSGCTT) subjected to either surveillance or active treatment (AT) after orchiectomy. However, data with long-term follow-up are unavailable. We tested contemporary treatment rates and their effect on cancer-specific mortality (CSM) and other-cause mortality (OCM) relative to surveillance, as well as after stratification between chemotherapy (CHT) versus retroperitoneal lymph node dissection (RPLND). Patients and Methods: We identified patients with stage I NSGCTT with initial orchiectomy within the Surveillance, Epidemiology, and End Results (SEER) database (1988-2015). Subsequent surveillance versus CHT versus RPLND use rates were reported. Cumulative incidence plots and multivariable competing-risks regression (CRR) models were used after propensity score (PS) matching. These tests first compared surveillance versus AT (CHT vs. RPLND) and subsequently CHT versus RPLND. Results: Of 5034 patients with stage I NSGCTT, 61.2%, 24.9%, and 13.9%, respectively, underwent surveillance, CHT, and RPLND. Between 1988 and 2015, surveillance (estimated annual percentage change [EAPC]: þ1.1%, P < .001) and CHT (EAPC: þ2.3%, P < .001) rates increased. RPLND rates decreased (EAPC: À5.7%; P < .001). After PS matching, CRR models failed to identify AT as an independent predictor of lower mortality relative to surveillance. However, after PS matching, CRR models identified RPLND as an independent predictor of lower CSM (hazard ratio, 0.26; P ¼ .002) relative to CHT. No difference in OCM rates was recorded (hazard ratio, 1.25; P ¼ .2).
Cancer, 1988
In order to define prognostic factors for advanced stage of nonseminomatous germ cell tumors (NSGCr) of the testis, the authors reviewed 84 patients treated from 1978 through 1985. The survival rate was 51% at 3 years. Patients with elevated seric levels of human chorionic gonadotropin (HCG) and/or alpha-fetoprotein (AFP), or the presence of an abdominal mass had significantly worse survival. Only HCG and AFP levels retained their significance when multivariate Cox analysis was performed. The probability that a patient achieves a complete remission (CR) was assessed by a function of certain patient characteristics using a multivariate logistic regression analysis. The significant variables were a function of HCG and AFP values. Since both variables are related to the CR rate and survival the authors define the obtention of a CR as a unique outcome of interest. The probability of a CR greater than 70% adequately separates the patients into two prognostic subgroups. This model currently is being used to enrole NSGCT patients in a prospective modulated clinical trial according to these prognostic factors.
Survival Analysis of Our Patients Diagnosed with Testicular Cancer
Eurasian Journal of Medical Investigation, 2022
A lthough testicular cancer accounts for only 1 percent of all cancers in men, it is the most common solid organ malignancy affecting men between the ages of 15 and 35. [1] Testicular cancer is also one of the best treatable solid malignancies, with a five-year survival rate of approximately 95 percent. [1,2] Germ cell tumors (GCTs) account for 95 percent of testicular cancers. They may consist of a single dominant histological pattern or represent a mixture of multiple histological types. In terms of treatment planning, testicular tumor is divided into 2 main categories: pure seminoma (no nonseminomatous element) and non-seminomatous germ cell tumors (NSGCTs). In most series, the ratio of seminoma to NSGCT is approximately one. Other testicular malignancies include sex cord-stromal tumors including Leydig cell and Sertoli cell tumors, gonadoblastoma and tumors of other cell types found in the testicles such as lymphoma, carcinoid tumors, and metastatic carcinoma. Objectives: The aim of our study is to determine the relationship between clinicopathological parameters and survival in our patients with testicular cancer who were followed up and treated in our centers. Methods: Patients who were followed up and treated with the diagnosis of testicular cancer in Antalya Training and
Journal of Clinical Oncology
PURPOSE The classification of the International Germ Cell Cancer Collaborative Group (IGCCCG) plays a pivotal role in the management of metastatic germ cell tumors but relies on data of patients treated between 1975 and 1990. MATERIALS AND METHODS Data on 9,728 men with metastatic nonseminomatous germ cell tumors treated with cisplatin- and etoposide-based first-line chemotherapy between 1990 and 2013 were collected from 30 institutions or collaborative groups in Europe, North America, and Australia. Clinical trial and registry data were included. Primary end points were progression-free survival (PFS) and overall survival (OS). The survival estimates were updated for the current era. Additionally, a novel prognostic model for PFS was developed in 3,543 patients with complete information on potentially relevant variables. The results were validated in an independent data set. RESULTS Compared with the original IGCCCG publication, 5-year PFS remained similar in patients with good pro...
Prognostic Factors of Testicular Cancer: A Single Institution Retrospective Study
The Egyptian Journal of Hospital Medicine
Background: Testicular cancer (TC) is the most common cancer in young males, representing about ~1% of new cases of cancer in male patients around the world. Objective: The study aims to assess prognostic factors of testicular cancer, overall survival and progression free survival. Patients and Methods: Sixty patients with testicular cancer who had been attended to the Clinical Oncology and Nuclear Department at Mansoura University Hospitals between January 2006 and Desember2020 were included in this retrospective analysis. Results: The median age of the patients was 43 years. The most common presentation was testicular mass (71.7%). Cryptorchidism was presented in 7 cases (11.7%). Most of our patients were germ cell tumors 51cases (85%) divided into seminoma 34 patients (56.7%), nonseminoma17 patients (28.3%), 7 patient (11.7 %) were nongerm cell tumors and 2 patients (3.3%) were miscellaneous tumors. Regarding tumor, node and metastasis (TNM) staging, 43 patients (71.7%) were stage I, and 14 patients (23.3%) were stage III. Regarding lymph node metastasis, 57 patients (95%) were N0. All patients underwent high inguinal orchiectomy, (80%) of patients received chemotherapy, and 7 patients (11.7%) received radiotherapy. The 5 years overall survival was (91.7%) while 5 years progression free survival was (88.3%). Conclusion: Absence of cryptorchidism, germ cell tumors, node negative and stage I all are good prognostic factors.