Predictors of Outcome in Patients with Advanced Nonseminomatous Germ Cell Testicular Tumors

Tarkan Yetisyigit,Banu Cicek Yalcin,Sener Cihan,Necati Alkis,Yuksel Urun,Burcin Budakoglu,Nurullah Zengin,Erkan Arpaci,Berna Oksuzoglu,Nuriye Yildirim,Nalan Babacan,Sercan Aksoy,Erdogan Selcuk Seber

doi:10.7314/apjcp.2014.15.2.831

Tarkan Yetisyigit, Banu Cicek Yalcin + Show 11 more

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https://doi.org/10.7314/apjcp.2014.15.2.831

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Abstract

Predictor factors determining complete response to treatment are still not clearly defined. We aimed to evaluate clinicopathological features, risk factors, treatment responses, and survival analysis of patient with advanced nonseminomatous GCTs (NSGCTs). Between November 1999 and September 2011, 140 patients with stage II and III NSGCTs were referred to our institutions and 125 patients with complete clinical data were included in this retrospective study. Four cycles of BEP regimen were applied as a first-line treatment. Salvage chemotherapy and/or high-dose chemotherapy (HDCT) with autologous stem cell transplantation were given in patients who progressed after BEP chemotherapy. Post-chemotherapy surgery was performed in selected patients with incomplete radiographic response and normal tumor markers. The median age was 28 years. For the good, intermediate and poor risk groups, compete response rates (CRR) were, 84.6%, 67.9% and 59.4%, respectively. Extragonadal tumors, stage 3 disease, intermediate and poor risk factors, rete testis invasion were associated with worse outcomes. There were 32 patients (25.6%) with non-CR who were treated with salvage treatment. Thirty-one patients died from GCTs and 94% of them had stage III disease. Even though response rates are high, some patients with GCTs still need salvage treatment and cure cannot be achieved. Non-complete response to platinium-based first-line treatment is a negative prognostic factor. Our study confirmed the need for a prognostic and predictive model and more effective salvage approaches.

Highlights

Testicular germ cell tumors (GCTs) accounts for only 1-2% of all male neoplasma but GCTs are the most common cancer of young men with the highest incidence in patients aged 15 to 40 years (Devesa et al, 1995; Beyer et al, 2013; Siegel et al, 2013)
We aimed to evaluate clinicopathological features, risk factors, treatment responses, and survival analysis of patient with advanced nonseminomatous GCTs (NSGCTs)
The data from this study show that extragonadal disease, stage 3 disease, intermediate and poor risk factors, and rete testis invasion were associated with response rate, PFS, and Overall survival (OS)

Summary

Introduction

Testicular germ cell tumors (GCTs) accounts for only 1-2% of all male neoplasma but GCTs are the most common cancer of young men with the highest incidence in patients aged 15 to 40 years (Devesa et al, 1995; Beyer et al, 2013; Siegel et al, 2013). Long-term disease free survival (DFS) cannot be achieved in 5-10% of patients and optimal salvage chemotherapy is still unknown for them (Motzer et al, 2012; Beyer et al, 2013). In this retrospective study, our aim was to evaluate clinicopathological features, risk factors, treatment responses, and survival analysis of patient with advanced NSGCTs. Predictor factors determining complete response to treatment are still not clearly defined. Our study confirmed the need for a prognostic and predictive model and more effective salvage approaches

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