Factors affecting prognosis in stage II and III testicular non-seminomatous germ cell tumors

Abstract

9701 Background: Some patients in advanced stage of testicular germ cell cancers die due to unresponsiveness to treatment or disease progression. Many prognostic factors have been investigated up to date. Results apropos MIB-1 and HER-2/neu are still conflicting. Methods: 58 cases were enrolled in the study. Initial serum AFP and βHCG, histopathology, relapse sites, persistent tumor marker elevation and tumor sites were noted. Cases were classified according to International germ cell consensus as good, intermediate and poor prognosis. Cross sections were obtained retrospectively from tissue blocks and MIB-1, HER-2/neu, vascular density were evaluated by immunohistochemical method. Vascular invasion was identified for all specimen. Results were analysed with uni and multivariate analysis. Results: 22% were primary refractory (100% died) and 20% were later-relapsed cases (33% died). 57%, 9% and 27% of the cases were classified as good, intermediate and poor risk groups, respectively. 31% in good, 11% in intermediate and 0% in poor risk groups could achieve remission after relapse. Most important prognostic factors were found tumor site, vascular density, initial serum tumor marker level, existance of yolk sac and choriocarcinoma components, relapse sites (lung vs other than lung), persistent tumor marker elevation in univariate analysis (p: 0.0001, p: 0.0005, p: 0.008, p: 0.0007, p: 0.0034, p: 0.0039, p: 0.0032, and p < 0.001). Tumor site, choriocarcinoma component and initial serum AFP level were most expressive prognostic factors in multivariate analysis (p: 0.0017, p: 0.049 and p: 0.0009). MIB-1 and HER-2/neu were not found prognosticator for survival neither for relapse. Survival was affected mainly by prognosis level (p<0.001). Vascular density and MIB-1 were different between never-relapsed, later-relapsed and primary refractory cases. Vascular invasion nor her-2/neu were different between the three groups. Conclusions: Although MIB-1 level was different in all prognostic groups, it was not significant as prognostic factor as her-2/neu in this study. Vascular density may be a good prognosticator as well as other known predictors. No significant financial relationships to disclose.