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Intermediate prognosis in metastatic germ cell tumours—outcome and prognostic factors

Seidel, Christoph; Daugaard, Gedske; Tryakin, Alexey; Necchi, Andrea; Cohn Cedermark, Gabriella; Ståhl, Olof LU ; Hentrich, Marcus; Brito, Margarida; Albany, Costantine and Taza, Fadi, et al. (2018) In European Journal of Cancer 94. p.16-25
Abstract

Background: For metastatic germ cell tumour patients with intermediate prognosis (IPGCT) according to the IGCCCG classification 5-year overall survival (OS) rates of 79% were described, but recent data suggest significant changes. Patients and methods: To compare the outcome of current IPGCT with former patients and to find new prognosticators a retrospective observational study was performed. Eligibility criteria were: age ≥16 years, diagnosed between 1979 and 2014. Primary end-point was the 5-year OS rate. Results: This database includes 707 IPGCT: group 1 was diagnosed 1979–1996 (n = 237), and group 2 1997–2014 (n = 470). Median follow-up was 8.6 years (IQR: 14.4). Group 1 and 2 received first-line treatment with BEP (median 4... (More)

Background: For metastatic germ cell tumour patients with intermediate prognosis (IPGCT) according to the IGCCCG classification 5-year overall survival (OS) rates of 79% were described, but recent data suggest significant changes. Patients and methods: To compare the outcome of current IPGCT with former patients and to find new prognosticators a retrospective observational study was performed. Eligibility criteria were: age ≥16 years, diagnosed between 1979 and 2014. Primary end-point was the 5-year OS rate. Results: This database includes 707 IPGCT: group 1 was diagnosed 1979–1996 (n = 237), and group 2 1997–2014 (n = 470). Median follow-up was 8.6 years (IQR: 14.4). Group 1 and 2 received first-line treatment with BEP (median 4 cycles; range 1–6) in 99% (group 1) and 95% (group 2), respectively. The proportion of first-line chemotherapy responders (CR and marker negative PR) was similar: 94% (group 1) and 96% (group 2), respectively (P = 0.290), but OS was superior in group 2 with a 5-year OS rate of 89% compared with 83% in group 1 (P = 0.035). In refractory disease, high-dose chemotherapy and treatment beyond second line was performed more often in group 2. A lactate dehydrogenase (LDH) cut-off value of 2 ULN (P = 0.002; HR 2.121) and alpha-fetoprotein (AFP) levels of 6200 IU/ml (P = 0.032; HR 2.155) pre-chemotherapy were independent prognosticators for OS in a multivariate analysis. Conclusion: Outcome of IPGCT has improved and is now closer to the good prognosis category. LDH and AFP levels represent potential markers to stratify IPGCT before treatment initiation.

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publication status
published
subject
keywords
IGCCCG classification, Intermediate prognosis, Outcome, Prognostic factors
in
European Journal of Cancer
volume
94
pages
10 pages
publisher
IFAC & Elsevier Ltd.
external identifiers
  • scopus:85042729562
ISSN
0959-8049
DOI
10.1016/j.ejca.2018.01.113
language
English
LU publication?
no
id
c11c5002-d3b7-44cc-8478-17d2f35a2a6a
date added to LUP
2018-03-28 11:06:40
date last changed
2019-08-14 04:13:10
@article{c11c5002-d3b7-44cc-8478-17d2f35a2a6a,
  abstract     = {<p>Background: For metastatic germ cell tumour patients with intermediate prognosis (IPGCT) according to the IGCCCG classification 5-year overall survival (OS) rates of 79% were described, but recent data suggest significant changes. Patients and methods: To compare the outcome of current IPGCT with former patients and to find new prognosticators a retrospective observational study was performed. Eligibility criteria were: age ≥16 years, diagnosed between 1979 and 2014. Primary end-point was the 5-year OS rate. Results: This database includes 707 IPGCT: group 1 was diagnosed 1979–1996 (n = 237), and group 2 1997–2014 (n = 470). Median follow-up was 8.6 years (IQR: 14.4). Group 1 and 2 received first-line treatment with BEP (median 4 cycles; range 1–6) in 99% (group 1) and 95% (group 2), respectively. The proportion of first-line chemotherapy responders (CR and marker negative PR) was similar: 94% (group 1) and 96% (group 2), respectively (P = 0.290), but OS was superior in group 2 with a 5-year OS rate of 89% compared with 83% in group 1 (P = 0.035). In refractory disease, high-dose chemotherapy and treatment beyond second line was performed more often in group 2. A lactate dehydrogenase (LDH) cut-off value of 2 ULN (P = 0.002; HR 2.121) and alpha-fetoprotein (AFP) levels of 6200 IU/ml (P = 0.032; HR 2.155) pre-chemotherapy were independent prognosticators for OS in a multivariate analysis. Conclusion: Outcome of IPGCT has improved and is now closer to the good prognosis category. LDH and AFP levels represent potential markers to stratify IPGCT before treatment initiation.</p>},
  author       = {Seidel, Christoph and Daugaard, Gedske and Tryakin, Alexey and Necchi, Andrea and Cohn Cedermark, Gabriella and Ståhl, Olof and Hentrich, Marcus and Brito, Margarida and Albany, Costantine and Taza, Fadi and Gerl, Arthur and Oechsle, Karin and Bokemeyer, Carsten},
  issn         = {0959-8049},
  keyword      = {IGCCCG classification,Intermediate prognosis,Outcome,Prognostic factors},
  language     = {eng},
  month        = {05},
  pages        = {16--25},
  publisher    = {IFAC & Elsevier Ltd.},
  series       = {European Journal of Cancer},
  title        = {Intermediate prognosis in metastatic germ cell tumours—outcome and prognostic factors},
  url          = {http://dx.doi.org/10.1016/j.ejca.2018.01.113},
  volume       = {94},
  year         = {2018},
}