Prognostic factors in patients with poor risk germ cell tumors : a retrospective analysis of the Indiana University experience from 1990-2014
Menée à partir de données portant sur 273 patients atteints d'une tumeur germinale métastatique au pronostic défavorable et traités entre 1990-2014 (durée médiane de suivi : 8 ans), cette étude identifie les facteurs associés à la progression de la maladie et au risque de décès
Background : Based on the risk stratification from the International Germ Cell Cancer Collaborative Group (IGCCCG), only 14% of patients with metastatic germ cell tumors (GCT) had poor risk disease with a 5 year progression-free survival (PFS) of 41% and a 5 year overall survival (OS) of only 48%. This analysis attempts to identify prognostic factors for patients with poor risk disease.
Patients and Methods : We conducted a retrospective analysis of all patients with GCT diagnosed and treated at Indiana University from 1990-2014. Clinical and pathological characteristics were available for all patients and all of them were treated with cisplatin-etoposide based chemotherapy. Cox proportional hazards models were used to target significant predictors of disease progression and mortality. A significance level of 5% was used in the analysis.
Results : We identified 273 consecutive patients with poor risk GCT (PRGCT). Median follow-up time was 8 years (range 0.03-24.5). 5 year PFS and OS were 58% (95% CI, 51% to 63%) and 73% (95% CI, 67% to 78%), respectively. In multivariate survival analyses, multiple risk factors were associated with disease progression including liver metastasis, brain metastasis, primary mediastinal non-seminomatous GCT (PMNSGCT), and elevation in logarithmic
β-hCG. Significant predictors of mortality were PMNSGCT (hazard ratio (HR) 4.63, 95% CI 2.25 to 9.56; P<0.001), brain metastasis (HR 3.30, 95% CI 1.74 to 6.23; P<0.001), and increasing age (HR 1.03, 95% CI 1.01 to 1.06; P=0.02).
Conclusions
:
Patients with PMNSGCT, brain metastasis, or with increasing age are at higher risk of death than their counterparts. This contemporary cohort (1990-2014) of 273 patients with PRGCT had improved PFS and OS outcomes than those from the historical IGCCCG group of patients (1975-1990).
Annals of Oncology , résumé, 2016