Abstract
PurposeTreatment of metastatic germ cell cancer (GCC) is based on the International Germ Cell Cancer Collaborative Group (IGCCCG) prognostic classification published in 1997. 5-year survival rates were reported to be 91%, 79%, and 48% for patients with good, intermediate and poor prognosis, respectively. However, treatment results may have improved over time due to cumulative experience, improved supportive care and modern-type chemotherapy.MethodsPatients with metastatic GCC who received cisplatin-based chemotherapy at two institutions in Munich between 2000 and 2013 were retrospectively studied. Clinical characteristics, treatment and outcomes were analyzed with respect to the IGCCG prognostic classification.ResultsOf 225 patients (median age 35 years), 72 (32%) had seminoma (S) and 153 (68%) nonseminoma. 175 (78%), 30 (13%) and 20 patients (9%) had good, intermediate and poor prognosis according to the IGCCCG classification. The 2-year-progression free survival of patients with good, intermediate and poor prognosis was 91%, 83% and 37%, and the 5-year-overall survival (OS) was 98%, 96%, and 66%, respectively. There was no significant difference in the OS between patients in the good and intermediate prognosis group.ConclusionCompared to data from the original IGCCCG classification system, the outcome of patients with metastatic GCC has considerably improved over time. While the prognosis of intermediate-risk patients is excellent, treatment in the poor-prognosis group remains to be improved.
Highlights
Testicular germ cell cancer is the most common cancer in men aged 18–40 years with an estimated 4120 new cases detected in Germany in 2016 (Robert-Koch-Institute 2019)
The cumulative 5-year-overall survival (OS) of relapsed patients was 75% without significant differences between the good, intermediate and poor prognosis group (Fig. 3) (P = 0.238)
Of 21 patients treated with first salvage cisplatin-based Conventional dose first salvage chemotherapy (CDCT) (n = 14) or carboplatin-based high-dose chemotherapy (HDCT) (n = 7) the International Prognostic Factors Study Group (IPFSG) scores were very low (n = 2), low (n = 3), intermediate (n = 5), high (n = 6), and very high (n = 5), respectively
Summary
Testicular germ cell cancer is the most common cancer in men aged 18–40 years with an estimated 4120 new cases detected in Germany in 2016 (Robert-Koch-Institute 2019). Treatment of metastatic germ cell cancer (GCC) is based on the 1997 International Germ Cell Cancer Collaborative Group (IGCCCG) prognostic classification (IGCCCG 1997; Beyer et al 2013; Albers et al 2015; Honecker et al 2018). Etoposide, bleomycin (BEP) combination chemotherapy have become standard of care for goodrisk patients while four cycles of BEP are the reference for intermediate- and poor-risk patients (Beyer et al 2013; Honecker et al 2018). Recent data indicate that the outcome of patients with metastatic GCC may have improved over time due to cumulative experience of treating physicians, improved supportive care and modern-type chemotherapy (van Dijk et al 2006; Raggi et al 2015). We presumed that the outcome of metastatic GCC has considerably improved compared to the original IGCCCG experience
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