Intermediate prognosis in metastatic germ cell tumors (IPGCT) : Outcome and prognostic stratification
(2018) In Annals of oncology : official journal of the European Society for Medical Oncology 29. p.325-325- Abstract
- Background: Germ cell tumor patients with intermediate prognosis (IPGCT) according to the IGCCCG classification represent a heterogeneous group exhibiting a variety of clinical features. We established a registry to identify prognostic markers to further characterize IPGCT.
Methods: A retrospective observational study was performed. Eligibility criteria were intermediate prognosis according to IGCCCG criteria, male sex, age ≥16 years. Patients were diagnosed from 1979 to 2014. Clinical characteristics were evaluated with uni- and multivariate analyses to detect new prognosticators. AFP and HCG were available in 85% and LDH levels in 72% of the cases, respectively. Overall survival (OS) was the primary endpoint.
Results:... (More) - Background: Germ cell tumor patients with intermediate prognosis (IPGCT) according to the IGCCCG classification represent a heterogeneous group exhibiting a variety of clinical features. We established a registry to identify prognostic markers to further characterize IPGCT.
Methods: A retrospective observational study was performed. Eligibility criteria were intermediate prognosis according to IGCCCG criteria, male sex, age ≥16 years. Patients were diagnosed from 1979 to 2014. Clinical characteristics were evaluated with uni- and multivariate analyses to detect new prognosticators. AFP and HCG were available in 85% and LDH levels in 72% of the cases, respectively. Overall survival (OS) was the primary endpoint.
Results: The database included n = 707 IPGCT with a median follow-up of 8.6 years (IQR: 14.4). First line cisplatin-based chemotherapy was administered to 701 patients (99%) and the 5-year OS rate was 87%. First diagnosis in the 1980s (n = 115), the 1990s (n = 158), and after 2000 (n = 434) were associated with 5-year OS rates of 81%, 85%, and 89%, respectively. Statistical analyses revealed AFP and LDH, but not HCG levels prior chemotherapy as prognosticators. A patient stratification according to AFP levels <1000 IU/ml (n = 360), 1000 to 2000 IU/ml (n = 77), >2000 to 5000 IU/ml (n = 93) and >5000 (n = 74) IU/ml prior first course of chemotherapy, revealed a significant correlation between AFP levels and OS, associated with 5-year OS rates of 89%, 87%, 86% and 82%, respectively (p = 0.037). LDH levels prior chemotherapy also correlated with outcome, associated with five-year OS rates of 92% for <2 ULN (n = 289), 88% for ≥2 to 3 ULN (n = 91), 80% for >3 to 4 ULN (n = 37), and 78% for >4 ULN (n = 89), respectively (p = 0.011). In multivariate analysis cut-off values of AFP levels >6000 IU/ml (p = 0.036; HR 2.096) and LHD levels >2 ULN (p = 0.02; HR 2.121) or > 3 ULN (p = <0.001; HR 2.305) were independent prognosticators for OS.
Conclusions: Prognostication according to LDH and AFP levels prior chemotherapy could offer a new approach to stratify IPGCT. The largest fraction of patients had AFP levels <2000 IU/ml and LDH <2 ULN associated with an outcome similar to the good prognosis category. These results need to be confirmed in the upcoming IGCCCG reclassification. (Less)
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- author
- publishing date
- 2018
- type
- Contribution to journal
- publication status
- published
- subject
- in
- Annals of oncology : official journal of the European Society for Medical Oncology
- volume
- 29
- pages
- 325 - 325
- publisher
- Oxford University Press
- external identifiers
-
- pmid:32136761
- ISSN
- 1569-8041
- DOI
- 10.1093/annonc/mdy283.123
- language
- English
- LU publication?
- no
- id
- 91084f9a-721a-48cc-aba5-f0bef160715a
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- 2020-03-31 13:53:52
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- 2023-04-18 22:40:38
@article{91084f9a-721a-48cc-aba5-f0bef160715a,
abstract = {{Background: Germ cell tumor patients with intermediate prognosis (IPGCT) according to the IGCCCG classification represent a heterogeneous group exhibiting a variety of clinical features. We established a registry to identify prognostic markers to further characterize IPGCT.<br>
<br>
Methods: A retrospective observational study was performed. Eligibility criteria were intermediate prognosis according to IGCCCG criteria, male sex, age ≥16 years. Patients were diagnosed from 1979 to 2014. Clinical characteristics were evaluated with uni- and multivariate analyses to detect new prognosticators. AFP and HCG were available in 85% and LDH levels in 72% of the cases, respectively. Overall survival (OS) was the primary endpoint.<br>
<br>
Results: The database included n = 707 IPGCT with a median follow-up of 8.6 years (IQR: 14.4). First line cisplatin-based chemotherapy was administered to 701 patients (99%) and the 5-year OS rate was 87%. First diagnosis in the 1980s (n = 115), the 1990s (n = 158), and after 2000 (n = 434) were associated with 5-year OS rates of 81%, 85%, and 89%, respectively. Statistical analyses revealed AFP and LDH, but not HCG levels prior chemotherapy as prognosticators. A patient stratification according to AFP levels <1000 IU/ml (n = 360), 1000 to 2000 IU/ml (n = 77), >2000 to 5000 IU/ml (n = 93) and >5000 (n = 74) IU/ml prior first course of chemotherapy, revealed a significant correlation between AFP levels and OS, associated with 5-year OS rates of 89%, 87%, 86% and 82%, respectively (p = 0.037). LDH levels prior chemotherapy also correlated with outcome, associated with five-year OS rates of 92% for <2 ULN (n = 289), 88% for ≥2 to 3 ULN (n = 91), 80% for >3 to 4 ULN (n = 37), and 78% for >4 ULN (n = 89), respectively (p = 0.011). In multivariate analysis cut-off values of AFP levels >6000 IU/ml (p = 0.036; HR 2.096) and LHD levels >2 ULN (p = 0.02; HR 2.121) or > 3 ULN (p = <0.001; HR 2.305) were independent prognosticators for OS.<br>
<br>
Conclusions: Prognostication according to LDH and AFP levels prior chemotherapy could offer a new approach to stratify IPGCT. The largest fraction of patients had AFP levels <2000 IU/ml and LDH <2 ULN associated with an outcome similar to the good prognosis category. These results need to be confirmed in the upcoming IGCCCG reclassification.}},
author = {{Seidel, C. and Daugaard, K. G. and Tryakin, A. and Necchi, A. and Cohn Cedermark, G. and Ståhl, O. and Hentrich, M. and Brito, M. and Albany, C. and Taza, F. and Gerl, A. and Oechsle, K. and Oing, C. and Bokemeyer, C.}},
issn = {{1569-8041}},
language = {{eng}},
pages = {{325--325}},
publisher = {{Oxford University Press}},
series = {{Annals of oncology : official journal of the European Society for Medical Oncology}},
title = {{Intermediate prognosis in metastatic germ cell tumors (IPGCT) : Outcome and prognostic stratification}},
url = {{http://dx.doi.org/10.1093/annonc/mdy283.123}},
doi = {{10.1093/annonc/mdy283.123}},
volume = {{29}},
year = {{2018}},
}