Management of the post-chemotherapy residual mass in patients with advanced stage non-seminomatous germ cell tumors (nsgct)

Objective:To compare the survival of patients with bilateral versus unilateral malignant ovarian germ cell tumors (OGCT).Methods:Patients with a diagnosis of OGCT were identified from the Surveillance, Epidemiology, and End Results Program for the period 1988 to 2006 and were divided into bilateral and unilateral subgroups. Only surgically treated patients were included. Histologic types were grouped into dysgerminoma, malignant teratoma, and mixed germ cell tumors with pure nondysgerminoma cell tumors. Statistical analysis using Wilcoxon rank sum test, Kaplan-Meier survival methods, and Cox proportional hazards regression model were performed.Results:In 1529 patients with OGCT, 1463 (95.7%) were unilateral and 66 (4.3%) were bilateral. Bilaterality was more common with dysgerminomas (6.5%) and mixed germ cell tumors with pure nondysgerminoma cell tumors (6.25%) than with immature teratomas (1.7%),P< 0.001. Most OGCT (67.3%) were stage I. Bilateral OGCT were more likely than unilateral tumors to be associated with advanced-stage disease (FIGO III and IV, 41% vs 20%,P< 0.04). Overall 5-year survival was 93.6% for unilateral OGCT and 80.7% in bilateral OGCT,P< 0.001. In multivariate analysis, bilaterality was not an independent predictor of survival when controlling for age, histology, stage, and surgical staging (hazard ratio, 1.3; 95% confidence interval, 0.7-2.5;P= 0.40).Conclusions:Compared with unilateral tumors, bilateral OGCT are more often associated with advanced-stage disease, high-risk histology, and poor survival. When other prognostic factors are accounted for, bilaterality was not an independent prognostic predictor of survival.

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Management of post-chemotherapy residual mass in patients with metastatic nonseminomatous germ cell tumors of the testis

Indian Journal of Urology ◽

10.4103/0970-1591.60448 ◽

2010 ◽

Vol 26 (1) ◽

pp. 98 ◽

Cited By ~ 1

Author(s):

DipenJ Parekh ◽

JohnP Fitzgerald ◽

Barbara Ercole

Keyword(s):

Germ Cell ◽

Germ Cell Tumors ◽

Residual Mass ◽

Nonseminomatous Germ Cell Tumors

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Patients with advanced-stage germ cell tumors have a high risk of thromboembolic events.

Journal of Clinical Oncology ◽

10.1200/jco.2013.31.15_suppl.e15621 ◽

2013 ◽

Vol 31 (15_suppl) ◽

pp. e15621-e15621

Author(s):

Anna Lina-Karin Gordy ◽

Mary J. Brames ◽

Lawrence H. Einhorn ◽

Naveen Manchanda

Keyword(s):

Logistic Regression ◽

High Risk ◽

Germ Cell ◽

Germ Cell Tumor ◽

Germ Cell Tumors ◽

Cell Tumor ◽

Advanced Stage ◽

Tumor Patients ◽

Poor Risk ◽

Relapsed Disease

e15621 Background: Thromboembolism (TE) accounts for significant morbidity and mortality in cancer patients. Rates of TE have been reported from 0.9%-28.0%, depending on the population. Patients with germ cell tumors have a 4.0-8.4% risk of TE following platin chemotherapy. Our patients are high-risk, many with advanced disease receiving high-dose chemotherapy and peripheral blood stem cell rescue. We sought to more completely understand TE events in advanced germ cell tumor patients. Methods: Forty-four consecutive patients visiting our germ cell tumor clinic between 11/05/2012 and 1/22/2013 were selected. Data were collected by retrospective chart review from tumor diagnosis until TE (ranging from TE on diagnosis to 20 years later). A logistic regression model was fitted to determine variables that predispose patients to TE. Results: In our patient series, seven (15.9%) had venous TE and none had arterial events. Five patients (11.4%) had TE within 16 weeks of chemotherapy, and 2 at 10 and 19 years after diagnosis, respectively. Two had bilateral pulmonary emboli (PE) (4.5%), 3 had upper or lower extremity DVTs, or both, and 1 had bilateral PE and DVTs. Five patients with TE had nonseminomatous tumors, 2 had non-testis primaries, 4 had relapsed disease, 2 with late relapse (>7 years), 6 had metastatic disease, 3 had retroperitoneal lymph node dissection, and all 7 received platin chemotherapy. In logistic regression analysis, significant risk factors for TE included relapse (P= .016), bulky retroperitoneal lymphadenopathy (P= .006), alpha-fetoprotein >10,000 (P= .047) beta-HCG > 1,000 (P= .020), chemotherapy (P= .031), platin-refractory disease (P= .055), and poor risk disease compared to good risk disease (P=.020). Conclusions: Germ cell tumor patients have a high risk of venous TE. Those with relapsed disease, bulky retroperitoneal lymphadenopathy, platin chemotherapy, platin-refractory, or poor risk disease are at increased risk. Our estimates are higher than previously reported and in contrast to earlier studies, do not include arterial TE. To confirm our findings, we will extend this study to 100 patients. If confirmed, this pattern of TE events may be a consequence of advanced stage disease in our patients.

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Prognostic significance of residual disease in advanced stage malignant ovarian germ cell tumors

Gynecologic Oncology ◽

10.1016/j.ygyno.2018.04.432 ◽

2018 ◽

Vol 149 ◽

pp. 190-191

Author(s):

D. Nasioudis ◽

E. Chapman-Davis ◽

M.K. Frey ◽

T.A. Caputo ◽

S.S. Witkin ◽

...

Keyword(s):

Germ Cell ◽

Residual Disease ◽

Prognostic Significance ◽

Germ Cell Tumors ◽

Advanced Stage

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Pattern of Relapse after First Line Treatment of Advanced Stage Germ-Cell Tumors

European Urology ◽

10.1016/j.eururo.2005.06.018 ◽

2005 ◽

Vol 48 (6) ◽

pp. 957-964 ◽

Cited By ~ 26

Author(s):

A. Fléchon ◽

S. Culine ◽

C. Théodore ◽

J.-P. Droz

Keyword(s):

Germ Cell ◽

Germ Cell Tumors ◽

Advanced Stage ◽

Line Treatment ◽

First Line ◽

First Line Treatment

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A retrospective analysis of the pattern of care and survival in patients with malignant ovarian germ cell tumors

South Asian Journal of Cancer ◽

10.4103/sajc.sajc_6_18 ◽

2019 ◽

Vol 08 (01) ◽

pp. 35-40 ◽

Cited By ~ 1

Author(s):

Reshu Agarwal ◽

Anupama Rajanbabu ◽

Pavithran Keechilattu ◽

Indu R. Nair ◽

D. K. Vijaykumar ◽

...

Keyword(s):

Germ Cell ◽

Germ Cell Tumors ◽

Disease Free Survival ◽

Stage I ◽

Surgical Staging ◽

Advanced Stage ◽

Pattern Of Care ◽

Survival Difference ◽

Fertility Sparing ◽

Incomplete Surgery

Abstract Objective: The objective of this study is to evaluate the pattern of care and survival outcome in patients with malignant ovarian germ cell tumors (MOGCTs). Materials and Methods: Between January 2004 and August 2017, 50 patients with MOGCT were identified at Amrita Institute of Medical Sciences and 48 included in analyses. Histologic subtypes were as follows: dysgerminoma 11; immature teratoma 16; yolk sac tumor 3; and mixed germ cell tumor 18. 31 (64.6% patients belonged to Stage I and 17 (35.4%) patients were advanced stage (Stage II-IV). Results: Median follow-up period was 34 months (range: 1–241 months). The 5- and 10-year disease-free survival (DFS) and overall survival (OS) for the entire cohort were 87.5% and 94.4%, respectively. DFS and OS of incomplete surgery Stage I patients 28.6% and 68.6%, respectively, were significantly lower than completely staged patients 100%. Out of 8 incomplete surgery patients, 5 recurred of which 2 died of disease within 4 and 9 months of recurrence. There was no survival difference with comprehensive surgical staging (CSS) and pediatric surgical staging (PSS) in Stage I MOGCT (DFS and OS 100%). Stage I dysgerminoma kept on active surveillance after PSS had equivalent survival of 100%. There was no survival difference in advanced stage MOGCT treated with primary debulking surgery and neoadjuvant chemotherapy (NAC) followed by fertility-sparing surgery (DFS and OS 100%). Conclusion: Incomplete surgery in Stage I MOGCT was associated with poor survival. There was no survival difference with CSS and PSS. NAC followed by surgery could be a reasonable option for patients of advanced stage MOGCT.

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The Use of Modified Templates in Early and Advanced Stage Nonseminomatous Germ Cell Tumor

Advances in Urology ◽

10.1155/2018/6783147 ◽

2018 ◽

Vol 2018 ◽

pp. 1-5 ◽

Cited By ~ 1

Author(s):

Timothy A. Masterson ◽

Clint Cary

Keyword(s):

Germ Cell ◽

Germ Cell Tumors ◽

Advanced Stage ◽

Motivating Factors ◽

Retroperitoneal Lymphadenectomy ◽

Surgical Decision ◽

Nonseminomatous Germ Cell Tumor ◽

Complex Process ◽

Stage Disease ◽

Surgical Decision Making

The surgical management of both early and advanced stage germ cell tumors of the testis remains a complex process of surgical decision making to maximize oncologic control while minimizing morbidity. Over the past 5 decades, the evolution of the surgical template for retroperitoneal lymphadenectomy (RPLND) has resulted in important modifications to achieve these goals. In this review, we will characterize the historical motivating factors that led to the modified template, outline patient and clinical factors in selecting these approaches in both early and advanced stage disease, and briefly discuss future horizons for their implementation.

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Prognostic significance of residual disease in advanced stage malignant ovarian germ cell tumors

International Journal of Gynecological Cancer ◽

10.1136/ijgc-2018-000013 ◽

2019 ◽

Vol 29 (3) ◽

pp. 554-559 ◽

Cited By ~ 4

Author(s):

Dimitrios Nasioudis ◽

Eloise Chapman-Davis ◽

Melissa K Frey ◽

Thomas A Caputo ◽

Steven S Witkin ◽

...

Keyword(s):

Overall Survival ◽

Germ Cell ◽

Cytoreductive Surgery ◽

Residual Disease ◽

Univariate Analysis ◽

Prognostic Significance ◽

Germ Cell Tumors ◽

Rank Test ◽

Advanced Stage ◽

Cancer Data

ObjectiveTo investigate the prognostic significance of complete gross resection following cytoreductive surgery for patients with advanced stage malignant ovarian germ cell tumors.MethodsThe National Cancer Data Base was accessed and patients diagnosed with an advanced stage (II-IV) malignant ovarian germ cell tumor who underwent primary cytoreductive surgery between 2011 and 2014 were selected for further analysis. For analysis purposes two groups were formed: patients with complete gross resection and those with macroscopic residual disease. Demographic and clinico-pathological characteristics were compared with the chi-square and Mann–Whitney U test. Univariate survival analysis was performed with the log-rank test after generation of Kaplan–Meier curves, while a Cox proportional hazard model was constructed to evaluate mortality after controlling for confounders.ResultsA total of 343 patients who met the inclusion criteria were identified. Residual disease status was available for 276 patients: the rate of complete gross resection was 69.2 %. By univariate analysis there was no difference in overall survival between patients in the complete gross resection and macroscopic residual disease groups, P= 0.26; 3-year overall survival rates: 86.4 % and 82.8 %, respectively. No difference in overall survival was noted following stratification by histology; P = 0.64 and P = 0.24 for dysgerminoma and non-dysgerminoma tumor groups. After controlling for stage IV disease, histology and the administration of chemotherapy, macroscopic residual disease was not associated with a worse mortality (HR: 1.22, 95% CI: 0.61 to 2.46).ConclusionsMacroscopic residual disease following primary cancer-directed surgery was not associated with a worse prognosis in a cohort of patients with advanced stage malignant ovarian germ cell tumors.

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