Is there an intermediate risk group of nonseminoma?

Abstract

323 Background: To evaluate predictive factors of testicular nonseminoma cancer. Methods: Between 2000 and 2012, 189 patients with testicular nonseminoma cancer were evaluated. Stages according to TNM classification were I, II, and III for 84 patients (60%), 49 (26%), and 56 (30%). The median age of the patients was 31 years (range 18-77 years). Treatment was based on orchiectomy plus chemotherapy (bleomycine/etoposide/cisplatin and vinblastine/ifosfamide/cisplatin) and retroperitoneal lymphadenectomy in residual disease. Treatment protocol was updated regularly according to international standards. Overall survival (OS) was evaluated according to the stage, Karnofsky index (KI), and dose intensity of chemotherapy with the Kaplan-Meier method at 5% significance level. Results: There was a significant difference between OS in patient with the different stages (log-rank test, p=0.000), however, detailed analysis revealed that there is significantly worse survival in stage IIIC only (10-years OS for IIIC vs. IIIA+B, 35% vs. 88%, p=0.001) while the difference among IIIB and lower stages was not significant (p=0.383) and 10-years OS was 94%. Dose intensity of chemotherapy proved to be a significant predictive factor for OS in stage IIIA+B patients. Patients with no dose reduction had a significantly higher OS than those with any kind of dose reduction (10-years OS 96% vs. 0%, log-rank test, p=0,000). In stage IIIC, however, the dose intensity had no influence on OS (log-rank test, p=0.167). Unlike dose intensity, in stage III disease KI had no prognostic significance for OS (KI<80 versus KI≥80, Log-rank test, p=0,627) and this is true both for stages IIIA+B and for stage IIIC. Conclusions: Standard of care in testicular nonseminoma cancer offers excellent prognosis with no significant differences in OS for good and intermediate risk groups. On the other hand, outcomes for stage IIIC are poor and further intensification of treatment is warranted. We have found no impact of performance status on OS neither for stage IIIA+IIIB nor stage IIIC. Reduction of chemotherapy dose has a negative impact on OS in patients with stage IIIA+IIIB and should be avoided if possible.