A retrospective analysis of patients with poor-risk germ cell tumor (PRGCT) treated at Indiana University from 1990 to 2011.

2014 ◽  
Vol 32 (15_suppl) ◽  
pp. 4557-4557 ◽  
Author(s):  
Nabil Adra ◽  
Aabha Oza ◽  
Costantine Albany ◽  
Sandra Althouse ◽  
Nasser H. Hanna ◽  
...  
Keyword(s):  
Germ Cell ◽  
Retrospective Analysis ◽  
Germ Cell Tumor ◽  
Cell Tumor ◽  
Indiana University ◽  
Poor Risk

A retrospective analysis of patients with poor-risk germ cell tumor (PRGCT) treated at Indiana University from 2000 to 2010.

2013 ◽  
Vol 31 (15_suppl) ◽  
pp. 4557-4557
Author(s):  
Nabil Adra ◽  
Costantine Albany ◽  
Daniel Sonnenburg ◽  
Yan Tong ◽  
Nasser H. Hanna ◽  
...  
Keyword(s):  
Germ Cell ◽  
Retrospective Analysis ◽  
Tumor Markers ◽  
Germ Cell Tumor ◽  
Germ Cell Tumors ◽  
Continuous Variable ◽  
Cell Tumor ◽  
P Value ◽  
Indiana University ◽  
Poor Risk

4557 Background: PRGCT represents 14% of germ cell tumors, with 2-year PFS of 50%. PRGCT is defined by primary mediastinal non-seminomatous germ cell tumor (PMNSGCT), non-pulmonary visceral metastasis (NPVM), AFP > 10,000 or hCG > 50,000. This analysis attempts to identify subsets of patients with more or less favorable outcomes among the poor risk groups. Methods: Retrospective analysis of all patients with testicular cancer seen at Indiana University (IU) from 2000-2010. 291 patients with PRGCT identified of whom 79 received initial therapy at IU. We analyzed the following variables: primary site testis/retroperitoneal (T/RP) vs. PMNSGCT, pulmonary vs. NPVM, and the amplitude of serum tumor markers. We identified groups of patients according to the level of tumor marker elevation with cutoff points of AFP 20,000 and hCG 200,000. Results: Mean age 29, mean AFP 8,283, mean hCG 185,667. 24% had PMNSGCT, 48% NPVM, 11% AFP>20,000, and 25% hCG>200,000. When hCG was analyzed as a continuous variable, every 10,000 unit increase in hCG caused the hazard of progression to increase by 1% (p value 0.01). Patients with NPVM had significantly worse PFS. NPVM with elevated hCG had worse outcome than NPVM with normal hCG. This did not correlate as well with AFP. PFS was worse with NPVM than elevated pre-chemotherapy tumor markers. Multiple different criteria for poor risk disease carried significantly worse impact on PFS and OS when compared to having a single criterion for poor risk disease. Conclusions: Our data indicate that patients with NPVM or more than one criteria for PRGCT have a worse outcome compared to other PRGCT subgroups. [Table: see text]

A retrospective analysis of patients with metastatic germ cell tumor (GCT) treated at Indiana University (IU) from 2000 to 2012.

2015 ◽  
Vol 33 (15_suppl) ◽  
pp. 4539-4539 ◽  
Author(s):  
Kimberly Ku ◽  
Samar Ibrahim ◽  
Nabil Adra ◽  
Sandra Althouse ◽  
Nasser H. Hanna ◽  
...  
Keyword(s):  
Germ Cell ◽  
Retrospective Analysis ◽  
Germ Cell Tumor ◽  
Cell Tumor ◽  
Indiana University

Smoking history and disease outcomes in patients with malignant germ cell tumors.

2013 ◽  
Vol 31 (15_suppl) ◽  
pp. 4561-4561
Author(s):  
Elizabeth O'Donnell ◽  
Kathryn P. Gray ◽  
Michelle S. Hirsch ◽  
Philip W. Kantoff ◽  
Clair Beard ◽  
...  
Keyword(s):  
Germ Cell ◽  
Germ Cell Tumor ◽  
Metastatic Disease ◽  
Cell Tumor ◽  
Wilcoxon Test ◽  
Smoking History ◽  
Poor Risk ◽  
Disease Outcomes ◽  
Good Risk ◽  
Line Chemotherapy

4561 Background: In 2011, of 8260 cases of Germ Cell Tumor (GCT) in the US, about 350 (4%) died of disease. The impact of smoking on disease outcomes of relapse and death is unknown. Methods: Retrospective review of 891 GCT pts treated at Dana-Farber Cancer Institute (DFCI) between 1997 and 2010 was conducted. Inclusion criteria were men age>18 yrs treated for GCT with a quantified smoking history in an electronic medical record. The outcomes of interest were relapse after first-line chemotherapy and death from the disease. A Chi-square or Fisher’s exact test assessed the association of the disease outcomes and the smoking history (heavy smoker vs. less), and a Wilcoxon test for ordered categories assessed the association of the outcomes with the IGCCCG risk groups (good, intermediate, and poor), stratified by histology (seminoma vs non-seminoma (NS)). Results: 327 men with metastatic disease were identified. Median age was 31.5 years. 47(14%) had a history of smoking >10 pack-years (pyrs). Of the 256 NSGCT pts with metastases at time of chemotherapy, pts who smoked >10 pyrs constituted 27% of the 64 relapses vs. 11% of the 192 non-relapses (Odds Ratio (OR) 2.9, p=0.003). Of the 71 metastatic seminoma pts, 40% of the 10 relapses had smoked >10 pyrs compared with 8% of the 61 pts who did not relapse (OR 7.5, p=0.01). Smoking >10 pyrs was associated with (i) higher IGCCCG risk at time of metastatic disease [24% of poor-risk pts had a >10 pyr history compared with 12% who had good-risk or 19% who had intermediate-risk (p=0.01)] and (ii) higher staging at initial diagnosis, 23% of poor-risk pts were heavy smokers compared with 9% who were CS1 and 12% good-risk (p=0.002). Of the 50 pts who died of metastatic disease, 36% had smoked >10 pyrs compared to 9% who were cured, Pts who smoked >10 pyrs had significantly increased odds of death compared to those who smoked 0-10 pyrs (OR=5.5, p <0.0001). 3 out of 30 pts who smoked >10 pyrs received suboptimal bleomycin, and only 1 relapsed. Conclusions: Greater than 10 pack-year smoking history is a modifiable risk factor associated with a higher IGCCCG risk at diagnosis of metastatic disease, higher risk of relapse after 1st-line chemotherapy and higher risk of death from germ cell tumor.

Incidence of Late-Relapse Germ Cell Tumor and Outcome to Salvage Chemotherapy

2005 ◽  
Vol 23 (28) ◽  
pp. 6999-7004 ◽  
Author(s):  
Ellen A. Ronnen ◽  
G. Varuni Kondagunta ◽  
Jennifer Bacik ◽  
Stephanie Marion ◽  
Dean F. Bajorin ◽  
...  
Keyword(s):  
Clinical Trial ◽  
Germ Cell ◽  
Retrospective Analysis ◽  
Germ Cell Tumor ◽  
Complete Response ◽  
Salvage Chemotherapy ◽  
Cell Tumor ◽  
Late Relapse ◽  
First Line ◽  
Line Chemotherapy

Purpose To define the incidence, clinical features, and outcome to salvage chemotherapy in patients with late-relapse germ cell tumor (GCT) after a complete response to first-line chemotherapy. Patients and Methods Two patient populations were examined. First, retrospective analysis of 246 patients treated on a clinical trial with salvage chemotherapy was performed; 29 patients with late-relapse GCT were identified and evaluated for treatment outcome and survival. Salvage regimens included paclitaxel, ifosfamide, and cisplatin, single agents, or a high-dose chemotherapy program. Second, the incidence of late relapse was assessed by retrospective analysis of 551 patients after a complete response (CR) to first-line chemotherapy. Results Twenty-nine patients received salvage chemotherapy on a clinical trial for late relapse GCT. The median survival was 23.9 months. At a median follow-up of 50.6 months, there were nine survivors. The chemotherapy regimens varied, but the only CRs were observed in patients treated with paclitaxel, ifosfamide, and cisplatin. Seven (50%) of 14 patients treated with paclitaxel, ifosfamide, and cisplatin achieved a continuous CR. Among the second population of 551 patients who had previously achieved a CR to a first-line chemotherapy trial, 17 were identified as having a late relapse (3%). The median time to relapse for these 17 patients was 7.8 years. Conclusion Late-relapse GCT is uncommon and is associated with a poor prognosis resulting from a high degree of resistance to chemotherapy. Chemotherapy with paclitaxel, ifosfamide, and cisplatin followed by surgery may be effective in patients with late-relapse GCT who are not considered candidates for primary surgery.

scholarly journals Klinefelter Syndrome with Poor Risk Extragonadal Germ Cell Tumor

2017 ◽  
Vol 10 ◽  
pp. 1-3 ◽  
Author(s):  
Jeremy A. Konheim ◽  
Jonathan A. Israel ◽  
Scott E. Delacroix
Keyword(s):  
Germ Cell ◽  
Germ Cell Tumor ◽  
Klinefelter Syndrome ◽  
Cell Tumor ◽  
Poor Risk ◽  
Extragonadal Germ Cell Tumor

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

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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