Viable Malignant Cells After Primary Chemotherapy for Disseminated Nonseminomatous Germ Cell Tumors: Prognostic Factors and Role of Postsurgery Chemotherapy—Results From an International Study Group

2001 ◽  
Vol 19 (10) ◽  
pp. 2647-2657 ◽  
Author(s):  
Karim Fizazi ◽  
Sergei Tjulandin ◽  
Roberto Salvioni ◽  
José R. Germà-Lluch ◽  
Jeannine Bouzy ◽  
...  
Keyword(s):  
Risk Factors ◽  
Prognostic Factors ◽  
Germ Cell ◽  
Risk Group ◽  
Germ Cell Tumors ◽  
Complete Resection ◽  
Postoperative Chemotherapy ◽  
Malignant Cells ◽  
Poor Risk ◽  
Nonseminomatous Germ Cell Tumors

PURPOSE: To assess the value of postsurgery chemotherapy in patients with disseminated nonseminomatous germ-cell tumors (NSGCTs) and viable residual disease after first-line cisplatin-based chemotherapy. PATIENTS AND METHODS: The outcome of 238 patients was reviewed. Tumor markers had normalized in all patients before resection. A multivariate analysis of survival was performed on 146 patients. RESULTS: The 5-year progression-free survival (PFS) rate was 64% and the 5-year overall survival (OS) rate was 73%. Three factors were independently associated with both PFS and OS: complete resection (P < .001), < 10% of viable malignant cells (P = .001), and a good International Germ Cell Consensus Classification (IGCCC) group (P = .01). Patients were assigned to one of three risk groups: those with no risk factors (favorable group), those with one risk factor (intermediate group), and those with two or three risk factors (poor-risk group). The 5-year OS rate was 100%, 83%, and 51%, respectively (P < .001). The 5-year PFS rate was 69% (95% confidence interval [CI], 62% to 76%) and 52% (95% CI, 40% to 64%) in postoperative chemotherapy recipients and nonrecipients, respectively (P < .001). No significant difference was detected in 5-year OS rates. After adjustment on the three prognostic factors, postoperative chemotherapy was associated with a significantly better PFS (P < .001) but not with better OS. Patients in the favorable risk group had a 100% 5-year OS, with or without postoperative chemotherapy. Postoperative chemotherapy appeared beneficial in both PFS (P < .001) and OS (P = .02) in the intermediate-risk group but was not statistically beneficial in the poor-risk group. CONCLUSION: A complete resection may be more critical than recourse to postoperative chemotherapy in the setting of postchemotherapy viable malignant NSGCT. Immediate postoperative chemotherapy or surveillance alone with chemotherapy at relapse may be reasonable options depending on the completeness of resection, IGCCC group, and percent of viable cells. Validation is necessary.

The Second Medical Research Council Study of Prognostic Factors in Nonseminomatous Germ Cell Tumors

1992 ◽  
Vol 10 (5) ◽  
pp. 867-867 ◽  
Author(s):  
G.M. Mead ◽  
S.P. Stenning ◽  
M.C. Parkinson ◽  
A. Horwich ◽  
S.D. Fossa ◽  
...  
Keyword(s):  
Prognostic Factors ◽  
Germ Cell ◽  
Medical Research ◽  
Research Council ◽  
Embryonal Carcinoma ◽  
Medical Research Council ◽  
Lung Metastases ◽  
Fibrous Tissue ◽  
Germ Cell Tumors ◽  
Nonseminomatous Germ Cell Tumors

In the report entitled, "The Second Medical Research Council Study of Prognostic Factors in Nonseminomatous Germ Cell Tumors" by Mead et al (J Clin Oncol 10:85–94, 1992), the second sentence in the Results section of the abstract should have read: "The independently adverse features proved to be (1) the presence of liver, bone, or brain metastases; (2) raised marker levels (alpha-fetoprotein [AFP] level > 1,000 kU/L or beta subunit of human chorionic gonadotropin [HCG] > 10,000 IU/L); (3) the presence of a mediastinal mass greater than 5 cm in diameter; (4) the presence of 20 or more lung metastases; (5) increasing age; and (6) absence of undifferentiated teratoma (embryonal carcinoma) or fibrous tissue from the primary tumor."

Prognostic factors and efficacy of different chemotherapeutic regimens in patients with mediastinal nonseminomatous germ cell tumors

2013 ◽  
Vol 140 (2) ◽  
pp. 311-318 ◽  
Author(s):  
Mikhail Fedyanin ◽  
Alexey Tryakin ◽  
Yana Mosyakova ◽  
Ilya Pokataev ◽  
Anatoly Bulanov ◽  
...  
Keyword(s):  
Prognostic Factors ◽  
Germ Cell ◽  
Germ Cell Tumors ◽  
Nonseminomatous Germ Cell Tumors

The Second Medical Research Council study of prognostic factors in nonseminomatous germ cell tumors. Medical Research Council Testicular Tumour Working Party.

1992 ◽  
Vol 10 (1) ◽  
pp. 85-94 ◽  
Author(s):  
G M Mead ◽  
S P Stenning ◽  
M C Parkinson ◽  
A Horwich ◽  
S D Fossa ◽  
...  
Keyword(s):  
Prognostic Factors ◽  
Germ Cell ◽  
Medical Research ◽  
Research Council ◽  
Medical Research Council ◽  
Lung Metastases ◽  
Large Population ◽  
Germ Cell Tumors ◽  
Cox Regression Analysis ◽  
Nonseminomatous Germ Cell Tumors

PURPOSE To assess prognostic factors in a large population of patients with metastatic nonseminomatous germ cell tumors (NSGCT) arising in gonadal or extragonadal sites. PATIENTS AND METHODS Data from 795 patients treated with chemotherapy between 1982 and 1986 in 13 centers were analyzed. Particular emphasis was placed on exact tumor measurements (eg, size of nodal masses, number of lung metastases), and the diagnostic pathology was also reviewed. Cox regression analysis was performed on these data. The patients were treated with a variety of cisplatin-containing chemotherapy regimens, 86% of which included etoposide. RESULTS With median follow-up of 45 months, overall 3-year survival is 85%. The independently adverse features proved to be (1) the presence of liver, bone, or brain metastases; (2) raised marker levels (alpha-fetoprotein [AFP] level greater than 1,000 kU/L or beta subunit of human chorionic gonadotropin [HCG] greater than 10,000 IU/L [corrected]); (3) the presence of a mediastinal mass greater than 5 cm in diameter; (4) the presence of 20 or more lung metastases; (5) increasing age; and (6) absence of undifferentiated teratoma (embryonal carcinoma) or fibrous tissue from the primary tumor. CONCLUSIONS The first four factors were used to define a simple prognostic classification. A good-prognosis group having none of these features comprised 67% of our patient population and had a 3-year survival of 93%. The remaining 33% of patients having at least one of these features had a 3-year survival rate of 68%. These patient groups are currently the subjects of international randomized clinical trials.

Histopathological and biological prognostic risk factors in low stage testicular nonseminomatous germ cell tumors

Der Urologe ◽  
1999 ◽  
Vol 38 (2) ◽  
pp. 168-178 ◽  
Author(s):  
A. Heidenreich ◽  
I. A. Sesterhenn ◽  
F. K. Mostofi ◽  
J. W. Moul ◽  
U. H. Engelmann
Keyword(s):  
Risk Factors ◽  
Germ Cell ◽  
Germ Cell Tumors ◽  
Prognostic Risk Factors ◽  
Nonseminomatous Germ Cell Tumors

A Suggested Prognostic Reclassification of Intermediate and Poor-Risk Nonseminomatous Germ Cell Tumors

2017 ◽  
Vol 15 (2) ◽  
pp. 306-312.e3 ◽  
Author(s):  
Andrea Necchi ◽  
Gregory R. Pond ◽  
Nicola Nicolai ◽  
Patrizia Giannatempo ◽  
Daniele Raggi ◽  
...  
Keyword(s):  
Germ Cell ◽  
Germ Cell Tumors ◽  
Poor Risk ◽  
Nonseminomatous Germ Cell Tumors

Prognostic factors in clinical stage I nonseminomatous germ cell tumors of the testis: multivariate analysis of a prospective multicenter study. Swedish-Norwegian Testicular Cancer Group.

1990 ◽  
Vol 8 (3) ◽  
pp. 509-518 ◽  
Author(s):  
O Klepp ◽  
A M Olsson ◽  
H Henrikson ◽  
N Aass ◽  
O Dahl ◽  
...  
Keyword(s):  
Prognostic Factors ◽  
Testicular Cancer ◽  
Germ Cell ◽  
Primary Tumor ◽  
Vascular Invasion ◽  
Clinical Stage ◽  
Germ Cell Tumors ◽  
Stage I ◽  
Retroperitoneal Lymphadenectomy ◽  
Nonseminomatous Germ Cell Tumors

Between 1981 and 1986, 279 consecutive patients with clinical stage I (CS1) nonseminomatous germ cell tumors (NSGCT) of the testis underwent pathological staging (PS) with retroperitoneal lymphadenectomy (RPLND). Patients with retroperitoneal metastases (PS2) received adjuvant chemotherapy. The median follow-up time after RPLND was 50 months (range, 30 to 90). Clinical and histopathologic features were registered prospectively and analyzed for association with risk of having PS2, relapse despite pathological stage 1 (PS1) or the combined risk of either event, metastatic disease (MET). Seventy-five (26.9%) of the patients had PS2 disease, and 30 (14.7%) of the 204 PS1 patients relapsed, indicating that at least 105 (37.6%) of this CS1 population had subclinical MET at the time of orchiectomy. Four (1.4%) of the 279 CS1 patients died of testicular cancer. Multivariate analyses showed several variables to be significantly associated with outcome for the CS1 patients; vascular invasion in primary tumor and normal preorchiectomy serum alpha-fetoprotein (Pre-AFP) level indicated PS2 disease. If Pre-AFP was excluded from the model, the absence of teratoma or yolk sac elements in the primary tumor became significant predictors of PS2. Vascular invasion, absence of teratoma, and a short interval between orchiectomy and RPLND indicated increased risk of relapse in PS1 patients. Vascular invasion, normal Pre-AFP, absence of teratoma elements, and a short orchiectomy to RPLND interval were predictive of MET. Our results indicate that prognostic factors useful for stratification of CS1 patients with NSGCT to different treatment options may be established.

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