666 A NOVEL RISK STRATIFICATION SYSTEM FOR CHEMOTHERAPY FAILURE IN TESTICULAR GERM CELL TUMOR

Abstract

You have accessJournal of UrologyPenis/Testis/Urethra: Benign & Malignant Disease I1 Apr 2012666 A NOVEL RISK STRATIFICATION SYSTEM FOR CHEMOTHERAPY FAILURE IN TESTICULAR GERM CELL TUMOR Jessica Lubahn, Nicholas Cost, Mehrad Adibi, Adam Romman, Ganesh Raj, Arthur Sagalowsky, and Vitaly Margulis Jessica LubahnJessica Lubahn Dallas, TX More articles by this author , Nicholas CostNicholas Cost Dallas, TX More articles by this author , Mehrad AdibiMehrad Adibi Dallas, TX More articles by this author , Adam RommanAdam Romman Dallas, TX More articles by this author , Ganesh RajGanesh Raj Dallas, TX More articles by this author , Arthur SagalowskyArthur Sagalowsky Dallas, TX More articles by this author , and Vitaly MargulisVitaly Margulis Dallas, TX More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2012.02.747AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES The initial management of testicular germ cell tumor (T-GCT) is tailored by TNMS staging to surveillance, retroperitoneal lymph node dissection (RPLND), platinum-based chemotherapy (CT), or radiation. Risk stratification according to the International Germ Cell Collaborative Group classification (IGCCG) determines the CT regimen. We present a novel classification system, which can be easily used to predict CT failure (CT-F). METHODS We reviewed an institutional T−GCT database and selected patients who had undergone any CT. CT-F was defined as tumor marker elevation following normalization, receiving any salvage CT, or presence of active GCT in post-CT RPLND. CT-F patients were compared to those successfully treated with CT (CT-S). Factors predictive of CT-F on univariate analysis were used to develop a risk scoring system (RSS). One point was allotted to each risk factor and summed into an overall score. The prognostic ability of the RSS was compared to the IGCCG by constructing Receiver Operating Curves (ROC). RESULTS 205 patients were reviewed (153 CT-S, 52 CT-F). Factors predictive of CT-F included post-orchiectomy AFP and HCG, number of metastatic sites, N and M status. Non-significant factors included histology (seminoma v non-seminoma), initial treatment modality, and T stage. The RSS, derived from the mean tumor marker values in the CT-F group, consisted of the following criteria: AFP>3000, HCG>50,000, LDH>800, N3, non-pulmonary visceral metastasis, and >3 metastatic sites. The RSS distribution was obtained for CT-S and CT-F (p=0.00) respectively: 0: 101(89.4%) vs. 12(10.6%), 1:39(71.0%) vs. 16(29.0%), 2: 4(30.8%) vs. 9(69.2%), >3: 2(14.3%) vs. 12(85.7%). The hazard ratios for scores 1,2, and >3 were 2.53, 6.62, and 22.2 respectively (p=0.00). The figure depicts time to CT-F, stratified by RSS. The calculated ROC for our RSS had an Area Under the Curve (AUC) of 0.78±0.04 (p=0.001) compared with the AUC of 0.72±0.48 (p=0.001) for the IGCCG classification. CONCLUSIONS This novel RSS more accurately predicts CT-F than the IGCCG criteria. It may be used to easily identify patients who would benefit from more aggressive CT regimens and to aid in risk-stratification for future study development. © 2012 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 187Issue 4SApril 2012Page: e271-e272 Advertisement Copyright & Permissions© 2012 by American Urological Association Education and Research, Inc.MetricsAuthor Information Jessica Lubahn Dallas, TX More articles by this author Nicholas Cost Dallas, TX More articles by this author Mehrad Adibi Dallas, TX More articles by this author Adam Romman Dallas, TX More articles by this author Ganesh Raj Dallas, TX More articles by this author Arthur Sagalowsky Dallas, TX More articles by this author Vitaly Margulis Dallas, TX More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...