Tumor suppressor aberrations and outcomes in localized and metastatic hormone sensitive prostate cancer (PrCa).

2018 ◽  
Vol 36 (6_suppl) ◽  
pp. 184-184
Author(s):  
Anis Hamid ◽  
Kathryn P. Gray ◽  
Grace Shaw ◽  
Laura E MacConaill ◽  
Carolyn Evan ◽  
...  
Keyword(s):  
De Novo ◽  
Cox Model ◽  
Clinical Stage ◽  
Prostate Gland ◽  
Local Therapy ◽  
Copy Number Loss ◽  
Castration Resistance ◽  
Psa Relapse ◽  
Localized Disease

184 Background: Aberrations of tumor suppressors (TS) TP53, PTEN and RB1 are recurrent genomic events in PrCa and associated with adverse clinical outcomes. Preclinical data suggest that cooperative functional loss of these genes drives development of even more aggressive disease phenotypes. Methods: We identified a retrospective cohort of men with PrCa who underwent DFCI Oncopanel targeted sequencing (NGS) on prostate gland (n = 230) or metastatic tissue (n = 7) for TP53, PTEN and RB1. Biomarker(BM)-positive was defined as copy number loss or likely deleterious mutation of ≥1 TS. For pts presenting with localized disease, Kaplan-Meier method estimated time from biopsy preceding local therapy to PSA relapse/metastasis/death (EFS), castration resistance (CRPC) and death (OS). Cox model assessed association of BM status and outcomes, adjusted for age, clinical stage and Gleason score in multivariate analyses (MVA). For M1 disease, time from ADT start to CRPC and death was estimated. We explored the association of cumulative BM-positive gene hits (0 vs 1 vs 2/3) with EFS (local disease) and OS (M1 disease). Results: Of pts presenting with localized disease (n = 205), 39% were BM-positive and 73 (36%) relapsed after median follow-up of 3.1 years. BM positivity was associated with significantly shorter EFS (driven by PSA relapse) (median 2.6 years, HR 1.95, 95% CI 1.22-3.13) and time to CRPC (HR 3.36, 95% CI 1.01-11.16). MVA confirmed the association with EFS (HR 1.84, p = 0.029). More gene hits lead to incremental risk of relapse (1 gene: HR 1.8, 95% CI 1.09-2.99; 2/3 genes: HR 2.68, 95% CI 1.27-5.63; both vs 0 hits) and this remained significant in MVA (1 gene: HR 1.75, p = 0.05; 2/3 genes: HR 2.74, p = 0.04). 43 patients had relapsed or de novo M1 disease. BM positivity (enriched at 63% of M1) was associated with poorer OS (10 deaths [of 27 BM-pos] vs 0 deaths [of 16 BM-neg] at median follow-up 3.3 years, HR not eval). A trend to incremental worse survival with cumulative gene hits was again observed. Conclusions: Deleterious TP53, PTEN and RB1 variants are associated with a short time to PSA relapse in localized disease, occur at a higher frequency in M1 disease and confer poorer OS. Worse outcomes are seen with cumulative gene hits.

Prognostic factors for overall survival in non-Hodgkin lymphomas: Nonlinear effect of continuous covariates.

2013 ◽  
Vol 31 (15_suppl) ◽  
pp. e19538-e19538
Author(s):  
Claudio J. Flores ◽  
Luis Augusto Casanova
Keyword(s):  
Overall Survival ◽  
Prognostic Factors ◽  
Nonlinear Effect ◽  
Cox Model ◽  
Clinical Stage ◽  
Performance Status ◽  
P Value ◽  
Continuous Covariates ◽  
Ann Arbor

e19538 Background: To evaluate prognostic factors in patients with primary non-Hodgkin lymphomas (NHL). Methods: We retrospectively analyzed prognostic factors (PFs) for overall survival (OS) in 2160 patients (pts) with NHL treated at INEN between 1990-2002. PFs were determinate according to Cox model with P-splines. Results: The median age was 54 years (range 14 - 96) and 51% were male. The majority of the pts had good performance status (73%, WHO 0-1). The Ann Arbor stage was I-II in 51%, III-IV in 49% and B symptoms were present in 38% of the pts. The hemoglobin (Hb) was low in 48%. Leukocytes (WBC), lymphocytes and LDH were elevated in 17.7%, 7.7% and 60% of pts, respectively. Of all patients, 709 (32.8 %) pts had died. The median follow-up was 12.6 months, with a median survival of 61.8 months and the survival rate at 5 and 10 years of 51.2 % and 41.7 % respectively. PFs identified were: age, sex, zubrod, clinical stage, Hb, leukocytes, lymphocytes and LDH. The following table shows the p-value and hazard ratio (HR). The effect of continuous covariates in the log(HR) is non-linear. The cutoff points of highest (HR >1) match the clinically defined ones, which are: age >60yrs, Hb<12g/dl and LDH >240UI/L. Both leukocytes and lymphocytes have two higher risk breakpoints: leukocytes >3x103 and >10x103, lymphocytes <20% and >60%. Conclusions: PFs for OS in our group of pts were similar to other reports in NHL. Age, Hb, leukocytes, and lymphocytes are relevant to OS, which showed a nonlinear effect in the log (HR). [Table: see text]

Standard versus saturation biopsy before primary focal cryosurgery of the prostate: Does it matter?

2015 ◽  
Vol 33 (7_suppl) ◽  
pp. 123-123
Author(s):  
Jamie Sungmin Pak ◽  
Philippa J. Cheetham ◽  
Aaron Katz ◽  
Sven Wenske
Keyword(s):  
Core Biopsy ◽  
Clinical Stage ◽  
Local Therapy ◽  
Tumor Grade ◽  
Biochemical Failure ◽  
Consecutive Series ◽  
Primary Concern ◽  
Saturation Biopsy ◽  
Chi Square Analysis

123 Background: Primary focal cryosurgery (PFC) has emerged as a viable option for local therapy in prostate cancer (PCa), most suitable for patients with clinical stage T1c-T3 disease of any tumor grade in whom potency is not of primary concern and who are not suitable for radical prostatectomy or radiation therapy. Success of 5-year biochemical recurrence (BCR)-free survival, depending on criteria, ranges from 60% to 90% in the literature. We hypothesize that saturation biopsy before PFC leads to lower rates of BCR compared to standard 12-core biopsy. Methods: We compiled a consecutive series of patients who underwent PFC at our institution for localized PCa. Parameters including demographics, PSA levels, and Gleason scores before primary treatment and at time of recurrence were assessed. Biochemical failure was defined by both Phoenix (PD) and Stuttgart (SD) definitions. Chi-square analysis was performed to compare outcomes. Results: One hundred and forty-seven patients underwent PFC at our institution between August 2000 and January 2014. Forty-five patients were excluded due to incomplete follow-up data and/or missing biopsy information. Median follow-up was 40.3 months (0.8-116, IQR 41). Conclusions: Zero of the six patients who underwent a saturation biopsy before PFC experienced biochemical failure or progression. This in contrast to those who underwent a standard 12-core biopsy before PFC, of which 19% experienced biochemical failure by PD and 26% by SD, and 6% underwent progression. This may be due to more informed selection for local therapy and more comprehensive assessment of the extent of tumor for treatment planning. Though these differences were not statistically significant in our study, we believe that our results lay the groundwork for a larger study to assess differences in outcomes after PFC depending on the extent of biopsy before treatment. [Table: see text]

Burden of metastatic hormone-sensitive prostate cancer to identify men more likely to benefit from early docetaxel.

2017 ◽  
Vol 35 (6_suppl) ◽  
pp. 136-136 ◽  
Author(s):  
Gwenaelle Gravis ◽  
Jean-Marie Boher ◽  
Yu-Hui Chen ◽  
Glenn Liu ◽  
Karim Fizazi ◽  
...  
Keyword(s):  
Overall Survival ◽  
De Novo ◽  
Local Treatment ◽  
Local Therapy ◽  
High Volume ◽  
Curative Intent ◽  
Consistent Effect ◽  
Visceral Metastases ◽  
Definition Of

136 Background: Patients with a low burden of metastatic disease and who relapse after localized therapy with curative intent have a longer overall survival. It is unclear whether these patients benefit from early docetaxel (D). Methods: Patients in GETUG-AFU15 (N = 385, median follow-up 84 mo) and CHAARTED (N = 790, median follow up 54 mo) were randomized to ADT alone or ADT + D and outcomes described using the same definition of high volume (HV) and low volume (LV) disease. (HV: visceral metastases and/or 4 or more bone metastases with at least one outside the axis) and whether the patients had prior local therapy or not. Results: Table 1 details across both studies that de novo HV group treated with ADT alone has the shortest overall survival and D has a consistent effect in improving OS. In contrast, in both studies patients with LV disease had a much longer OS with no evidence that D improved OS. Conclusions: There was no apparent survival benefit in CHAARTED and GETUG-15 studies with D for LV whether patients had prior local treatment or not. Across both studies, early D had a consistent effect and improved OS in HV pts especially those with no prior local therapy. Partial Support and drug supply by Sanofi. Clinical trial information: NCT00104715, NCT00309985. [Table: see text]

DNA damage and repair (DDR) gene variants and outcomes in localized and metastatic prostate cancer (mPC).

2018 ◽  
Vol 36 (6_suppl) ◽  
pp. 304-304
Author(s):  
Brandon David Bernard ◽  
Kathryn P. Gray ◽  
Grace Shaw ◽  
Laura E MacConaill ◽  
Carolyn Evan ◽  
...  
Keyword(s):  
Cox Regression ◽  
Low Frequency ◽  
Gene Variants ◽  
Castration Resistance ◽  
Dna Damage And Repair ◽  
Free Survival ◽  
Targeted Next Generation Sequencing ◽  
Death Time ◽  
Psa Relapse

304 Background: Moderate frequencies of DDR gene variants exist in mPC. Their prognostic role in localized and mPC is unclear. This study aims to characterize DDR variants in a cohort of hormone sensitive localized and mPC and assess for association with outcome. Methods: A retrospective cohort of men with PC and ≥ 2 follow up visits at DFCI and targeted next generation sequencing of prostate or metastatic tissue was identified. Biomarker (BM) positive was defined as pathogenic changes in the following DDR genes: ATM BAP1 BRCA1 BRCA2 BRIP1 CHEK2 MSH2 MSH6 PALB2 PMS2. For localized PC, outcome endpoints included event-free survival (EFS) (time from prostate biopsy to PSA relapse/metastasis/death), metastasis-free survival (MFS) (time to metastasis/death), time to castration resistance (CRPC), and death (OS); for mPC, outcome events included time from androgen deprivation start to CRPC and OS. BM status was descriptively summarized. Kaplan-Meier method and Cox regression model assessed associations of BM status with clinical outcomes. Results: Of the 237 men included, 16 (7%) were BM positive; 12 (6%) in 205 localized PC, 6 (14%) in 43 mPC. BM positive genes included 9 (4%) ATM, 6 (3%) BRCA2, and 2 (0.8%) CHEK2. In men with localized PC, EFS events occurred in 58% (7/12) BM positive vs 34% (66/193) BM negative at median follow up of 3.1 years; BM positive trended toward a shorter EFS (median 1.9 vs 5 years) than BM negative (HR 2.17, 95%CI 0.99-4.76). MFS events were observed in 17% (2/12) BM positive vs 7% (15/193) BM negative. CRPC events occurred in 17% (2/12) BM positive vs 6% (11/193) BM negative. In men with mPC, there were CRPC events in 100% (6/6) BM positive vs 67% (25/37) BM negative at median follow up of 3.3 years; BM positive trended toward a shorter time to CRPC (median 4 vs 8.8 months) compared to BM negative (HR 1.87, 95%CI 0.76-4.64). There was no association between BM status and OS. Conclusions: DDR variants appear infrequently in localized PC but may portend a shorter time to PSA relapse and metastasis. Similarly, DDR variants in mPC may be associated with a shorter time to CRPC. Low frequency of variants and short follow up limit these analyses. The prognostic value of DDR variants remains unclear and requires further research.

scholarly journals Outcome of Men With Relapses After Adjuvant Bleomycin, Etoposide, and Cisplatin for Clinical Stage I Nonseminoma

2020 ◽  
Vol 38 (12) ◽  
pp. 1322-1331 ◽  
Author(s):  
Stefanie Fischer ◽  
Torgrim Tandstad ◽  
Gabriella Cohn-Cedermark ◽  
Constance Thibault ◽  
Bruno Vincenzi ◽  
...  
Keyword(s):  
Metastatic Disease ◽  
De Novo ◽  
Clinical Stage ◽  
Stage I ◽  
Risk Of Death ◽  
First Relapse ◽  
Time To Relapse ◽  
Disease Free ◽  
Subsequent Relapse

PURPOSE Clinical stage I (CSI) nonseminoma (NS) is a disease limited to the testis without metastases. One treatment strategy after orchiectomy is adjuvant chemotherapy. Little is known about the outcome of patients who experience relapse after such treatment. PATIENTS AND METHODS Data from 51 patients with CSI NS who experienced a relapse after adjuvant bleomycin, etoposide, and cisplatin (BEP) from 18 centers/11 countries were collected and retrospectively analyzed. Primary outcomes were overall and progression-free survivals calculated from day 1 of treatment at first relapse. Secondary outcomes were time to, stage at, and treatment of relapse and rate of subsequent relapses. RESULTS Median time to relapse was 13 months, with the earliest relapse 2 months after start of adjuvant treatment and the latest after 25 years. With a median follow-up of 96 months, the 5-year PFS was 67% (95% CI, 54% to 82%) and the 5-year OS was 81% (95% CI, 70% to 94%). Overall, 19 (37%) of 51 relapses occurred later than 2 years. Late relapses were associated with a significantly higher risk of death from NS (hazard ratio, 1.10 per year; P = .01). Treatment upon relapse was diverse: the majority of patients received a combination of chemotherapy and surgery. Twenty-nine percent of patients experienced a subsequent relapse. At last follow-up, 41 patients (80%) were alive and disease-free, eight (16%) had died of progressive disease, and one patient (2%) each had died from therapy-related or other causes. CONCLUSION Outcomes of patients with relapse after adjuvant BEP seem better compared with patients who experience relapse after treatment of metastatic disease but worse compared with those who have de-novo metastatic disease. We found a substantial rate of late and subsequent relapses. There seem to be three patterns of relapse with different outcomes: pure teratoma, early viable NS relapse (< 2 years), and late viable NS relapse (> 2 years).

Early results of prostate cancer radiation therapy at Korle Bu Teaching Hospital: An analysis with emphasis on research strategies to improve treatment delivery and outcomes among patients in Ghana.

2012 ◽  
Vol 30 (15_suppl) ◽  
pp. e15163-e15163
Author(s):  
Kosj Yamoah ◽  
Kwamena Beecham ◽  
Sarah Hegarty ◽  
Terry Hyslop ◽  
Timothy Norman Showalter ◽  
...  
Keyword(s):  
Prostate Cancer ◽  
Metastatic Disease ◽  
External Beam Radiotherapy ◽  
Clinical Stage ◽  
Specific Antigen ◽  
Local Therapy ◽  
The United States ◽  
Related Factors ◽  
Early Results

e15163 Background: Although there is interest in racial disparities in prostate cancer outcomes among persons of African descent living in the United States there is scant data available regarding disease presentation and treatment response among black men living in Africa. In this study we evaluate disease presentation and early clinical outcomes among Ghanaian men with prostate cancer treated with external beam radiotherapy (EBRT). Methods: A total of 379 men with prostate cancer were referred to the National Center for Radiotherapy and Nuclear Medicine, Ghana, from January 2003 to December 2009. Data were collected regarding patient- and tumor-related factors such as age, prostate specific antigen (PSA), Gleason score, clinical stage, and use of hormonal therapy. For patients who received EBRT, freedom from biochemical failure (FFbF) was evaluated using Kaplan-Meier analysis. Results: The median age at diagnosis was 65 years. Of 379 patients referred for treatment 69.6% of all patients had initial PSA >20ng/ml, and the median iPSA was 39.0 ng/ml. A total of 128 men representing 33.8% of overall cohort were diagnosed with metastatic disease at time of referral. We identified 166 men treated with EBRT or brachytherapy +/- androgen depravation therapy (ADT), and an additional 139 men treated with ADT alone (including orchiectomy in 38 patients). The median EBRT dose was 70 Gy, in 2 Gy per fraction. Among all EBRT patients with at least 2 years of follow-up after treatment (n=52; median follow-up time: 38.9 months), 5-year actuarial FFbF was 65.1%: 67.0% for patients with PSA < 30.0 ng/mL and 63.2% for PSA ≥ 30.0 ng/mL [log-rank, p=0.586]. Conclusions: This is the largest series reporting on outcomes for prostate cancer treatment in West Africa. That one-third of patients presented with metastatic disease suggests potential need for earlier detection of prostate cancer to permit curative-intent local therapy. Data from this study will aid in the strategic development of a prostate cancer research roadmap in Ghana, with a focus on improving therapeutic approach as well as fostering a prudent allocation of scarce resources.

Clinicopathological Analysis of 32 Cases of Extra-Medullary Myeloid Tumour.

Blood ◽  
2007 ◽  
Vol 110 (11) ◽  
pp. 4317-4317
Author(s):  
Tony Todd ◽  
Martin W. Besser ◽  
Jenny I. Craig ◽  
Robert E. Marcus
Keyword(s):  
De Novo ◽  
Diagnostic Delay ◽  
Disease Free Survival ◽  
Local Therapy ◽  
Clinicopathological Analysis ◽  
Tumour Bulk ◽  
Long Term Survivors ◽  
Immunohistochemical Stains

Abstract We performed a retrospective analysis of 32 cases of extramedullary myeloid tumour in patients aged 11 weeks – 85 years (median 26 years), identified from the records of the Addenbrooke’s Hospital Department of Pathology over a 10 year period from 1st January 1997 to 15th January 2007. Records were reviewed for diagnosis, immunohistochemical stains, demographics, clinical and radiological features, treatment and outcome. 9 patients (28%) had a pre-existing haematological disorder, 6 (19%) presented with simultaneous EMMT and leukaemia, and 17 cases (53%) with de novo isolated EMMT. The most commonly positive immunohistochemical stains were CD43 (100%), CD45 (95%), CD68-PGM1 (91%), MPO (83%), CD 15 (78%) and CAE (73%). None of the 26 cases tested was positive for CD3, cytokeratin was negative in all tested patients, two cases were positive for CD79a, 9 of 9 cases were strongly positive for MIB1, 6 of 6 were positive for bcl-2, and vimentin positive in 3 of 3 cases. Misdiagnosis occurred in 10 out of the 17(59%) isolated de novo presentations. These were thought to be lymphoma (6/10), sarcoma (1/10), plasmacytoma (1/10), rhabdomyosarcoma (1/10) and fibromyomatosis (1/10). All the bcl-2 positive cases were misdiagnosed as non-Hodgkin’s lymphoma, even in the absence of specific B- or T-cell markers, and 1 vimentin positive case as sarcoma. No misdiagnosed case was initially tested for chloroacetate esterase or myeloperoxidase, in 9 subsequent testing showed one or both to be positive. 9 of 32 cases were (28%) long term survivors with a median follow up 1610 days, 7 adults and 2 children. Two received local therapy only with excision and radiotherapy, all others received intensive AML chemotherapy. There was only 1 long term survivor of the 6 patients initially given non-AML chemotherapy as a result of misdiagnosis. In that patient the diagnosis was revised within 14 days. All other misdiagnosed patients treated with non AML chemotherapy progressed to AML and were unsalvageable. Isolated EMMT may give rise to significant diagnostic difficulty. These tumours are usually positive for CD45, MPO and CAE but unless these are tested for, isolated expression of vimentin and bcl-2 may be misleading. In our series outcome was adversely affected by diagnostic delay, initial non-AML therapy, lymphadenopathy and tumour bulk (>10cm) at diagnosis. In correctly diagnosed patients AML chemotherapy alone may be sufficient to achieve long-term disease free survival in contrast to other recently published studies.

Salvage surgery for local recurrence after breast conservation therapy—Is re-lumpectomy an appropriate treatment?

2006 ◽  
Vol 24 (18_suppl) ◽  
pp. 608-608
Author(s):  
T. Ofuchi ◽  
A. Amemiya ◽  
M. Ono ◽  
J. Hatayama ◽  
A. Takeda
Keyword(s):  
Local Recurrence ◽  
Local Control ◽  
Systemic Therapy ◽  
Salvage Surgery ◽  
Clinical Stage ◽  
Breast Conservation ◽  
Local Therapy ◽  
Stage I ◽  
Immediate Reconstruction

608 Background: Since 1983 through 2005, 2439 clinical stage I or II patients (pts) were treated with lumpectomy and postoperative irradiation. During median follow-up of 75 months, 142 patients experienced local recurrence as first and sole event were judged as candidate for further local therapy. The purpose of this study is to evaluate the outcome of salvage treatment, with specific reference to feasibility of second breast conservation surgery. Methods: Among those with operable local recurrences, 73 pts who requested conservation of their breasts and whose recurrences were judged to be small enough to be locally re-excised with adequate margins underwent second lumpectomy (Re-LMP). 51 pts were treated by mastectomy with or without immediate reconstruction (MAS). Adjuvant systemic therapy of limited duration was given at the discretion of patients and therapists. Survival and local re-recurrence after salvage surgery were estimated by Kaplan-Meier method. Results: Age of patients ranged from 28–69 (mean: 41). Median follow-up length after salvage surgery was 53 months (6–194 months). Patient/Tumor characteristics were similar in Re-LMP and MAS groups. Local re-recurrence: Re-LMP: 31 pts developed in-breast re-recurrence (34% at 3yrs, 49% at 5yrs). MAS: 6 pts experienced chest wall recurrence (11% at 3yrs, 11% at 5yrs, p=0.0005). Independent risk factor for re-recurrence was not identified. Survival: In initial clinical stage I patients, 3 pts treated with Re-LMP died after salvage surgery and all treated with MAS survived (94% and 100% at 5yrs, p=0.2). In clinical stage II patients, 6 in Re-LMP and 8 patients in MAS died (89%, 57% at 5yrs after salvage surgery, p=0.02). Poor prognostic factors for both groups were initial stage and stage at the time of local failure. Conclusions: For an isolated in-breast recurrence, salvage mastectomy with or without immediate reconstruction provides excellent local control. At the present time, mastectomy should be offered as 1st treatment option. Although survival is not jeopardized, Re-LMP alone does not offer adequate local control. Additional local therapy i.e. re-radiotherapy or aggressive systemic therapy may improve this poor result. Prospective studies should be initiated. No significant financial relationships to disclose.

Outcome of men with relapses after adjuvant BEP for clinical stage I nonseminoma.

2019 ◽  
Vol 37 (7_suppl) ◽  
pp. 510-510 ◽  
Author(s):  
Stefanie Christine Fischer ◽  
Torgrim Tandstad ◽  
Gabriella Elisabeth Cohn-Cedermark ◽  
Constance Thibault ◽  
Bruno Vincenzi ◽  
...  
Keyword(s):  
De Novo ◽  
Clinical Stage ◽  
Mature Teratoma ◽  
Cell Cancer ◽  
Good Prognosis ◽  
Stage I ◽  
Risk Of Death ◽  
Primary Endpoints ◽  
Time To Relapse

510 Background: Clin. stage I (CSI) non-seminoma (NS) is disease limited to the testis without metastases. One treatment strategy after orchiectomy is adjuvant (adjuv) chemotherapy with BEP after which relapses are rare. Little is known about the outcome of patients (pts) relapsing after such treatment. Methods: Data from 51 pts with CSI NS and relapse after adjuv BEP from 18 centers/11 countries was collected and retrospectively analyzed. Primary endpoints were OS and PFS calculated from start of treatment of relapse. Secondary outcomes were time to, stage at, and treatment of relapse as well as rate of subsequent relapses. Results: 23 pts received one cycle adjuv BEP and 28 pts two. Median time to relapse was 13 months, with the earliest relapse two months after start of adjuv BEP and the latest relapse recorded after 26 years. According to IGCCCG, 84% of pts classified as good prognosis at relapse. With a median follow up of 50 months 5y PFS was 64% (95% CI 52-80%) and 5y OS 79% (95% CI 68-92%). Treatment upon relapse was diverse, the majority of pts received combination- chemotherapy and surgery. 10 pts (20%) had pure mature teratoma at relapse treated with surgery alone. None of these pts experienced a second relapse. If teratoma relapses were excluded, 5y PFS dropped to 58% (44-77%) and 5y OS to 76% (63-92%). Relapses later than three years after adjuv therapy occured in 15/51 pts. (29%) and were associated with a statistically significant higher risk of death from germ-cell cancer (p=0.02). 15/51 pts (29%) experienced a subsequent relapse. Excluding pts with teratoma only, subsequent relapses occured in 15 of the remaining 41 pts (37%). At last follow-up, 41/51 (80%) pts were alive and disease-free, 8/51 (16%) had died from progressive disease and one pt each had died from therapy-related or other causes. Conclusions: Outcome of pts with relapse after adjuv BEP seems to be better compared to pts with relapse after metastatic disease, but worse compared to de novo metastatic pts. There is a substantial rate of late and subsequent relapses. Pts and care-takers need to be informed about this and therapy intensification at first relapse might be considered. However, considering the low rate of relapses, OS in general for CSI NS pts receiving adjuv BEP is excellent.

Nichtseminom Stadium I: Was in der Rezidivsituation beachtet werden muss

2021 ◽  
pp. 1-2
Author(s):  
Jonas Busch
Keyword(s):  
Metastatic Disease ◽  
De Novo ◽  
Clinical Stage ◽  
Risk Of Death ◽  
First Relapse ◽  
Stadium I ◽  
Time To Relapse ◽  
Disease Free ◽  
Subsequent Relapse

<b>Purpose:</b> Clinical stage I (CSI) nonseminoma (NS) is a disease limited to the testis without metastases. One treatment strategy after orchiectomy is adjuvant chemotherapy. Little is known about the outcome of patients who experience relapse after such treatment. <b>Patients and methods:</b> Data from 51 patients with CSI NS who experienced a relapse after adjuvant bleomycin, etoposide, and cisplatin (BEP) from 18 centers/11 countries were collected and retrospectively analyzed. Primary outcomes were overall and progression-free survivals calculated from day 1 of treatment at first relapse. Secondary outcomes were time to, stage at, and treatment of relapse and rate of subsequent relapses. <b>Results:</b> Median time to relapse was 13 months, with the earliest relapse 2 months after start of adjuvant treatment and the latest after 25 years. With a median follow-up of 96 months, the 5-year PFS was 67% (95% CI, 54% to 82%) and the 5-year OS was 81% (95% CI, 70% to 94%). Overall, 19 (37%) of 51 relapses occurred later than 2 years. Late relapses were associated with a significantly higher risk of death from NS (hazard ratio, 1.10 per year; P = .01). Treatment upon relapse was diverse: the majority of patients received a combination of chemotherapy and surgery. Twenty-nine percent of patients experienced a subsequent relapse. At last follow-up, 41 patients (80%) were alive and disease-free, eight (16%) had died of progressive disease, and one patient (2%) each had died from therapy-related or other causes. <b>Conclusion:</b> Outcomes of patients with relapse after adjuvant BEP seem better compared with patients who experience relapse after treatment of metastatic disease but worse compared with those who have de-novo metastatic disease. We found a substantial rate of late and subsequent relapses. There seem to be three patterns of relapse with different outcomes: pure teratoma, early viable NS relapse (&#x3c; 2 years), and late viable NS relapse (&#x3e; 2 years).

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