Hartmann J T, Einhorn L, Nichols C R, Droz J P, Horwich A, Gerl A, Fossa S D, Beyer J, Pont J, Schmoll H J, Kanz L, Bokemeyer C
Tuebingen University Medical Center II, Tuebingen, Germany.
J Clin Oncol. 2001 Mar 15;19(6):1641-8. doi: 10.1200/JCO.2001.19.6.1641.
Relapsed extragonadal germ cell tumors patients (EGGCT) are treated with identical salvage chemotherapy regimens, as are patients with metastatic testicular cancer. This investigation evaluates the results of second-line chemotherapy in nonseminomatous EGGCT and tries to identify prognostic factors for survival.
We conducted a retrospective review of 142 patients treated at eleven European and American centers between 1975 and 1996. All had received cisplatin-containing regimens as induction treatment.
Twenty-seven of 142 patients (19%) were long-term disease-free, 11% with primary mediastinal and 30% of patients with primary retroperitoneal disease. Median follow-up since start of salvage treatment was 11 months (range, 1 to 157) for all patients and 45 months (range, 6 to 157) for surviving patients. Forty-eight patients (34%) received high dose chemotherapy with autologous bone marrow transplant at relapse, and 10 of these patients (21%) are continuously disease-free. Primary mediastinal location (P =.003), sensitivity to cisplatin (P =.003), elevated beta-HCG at relapse (P: =.04), and normal LDH at diagnosis (P =.01) were shown to be significant negative prognostic factors for overall survival in univariate; mediastinal location [relative risk ratios (HR) = 1.9; 95% confidence intervals (CI), 1.2 to 3.0] and sensitivity to cisplatin [HR = 2.4; 95% CI, 1.1 to 5.2] were significant negative prognostic factors in multivariate analysis.
Although current salvage strategies will cure between 20% and 50% of recurrent metastatic testicular cancer, relapsed nonseminomatous EGGCT patients appear to have an inferior survival rate, in particular in case of primary mediastinal location. Mediastinal primary tumor and inadequate response to cisplatin-based induction chemotherapy have been identified as independent negative prognostic factors, both associated with an approximately two-fold higher risk for failure of salvage treatment.
复发性性腺外生殖细胞肿瘤患者（EGGCT）与转移性睾丸癌患者接受相同的挽救性化疗方案。本研究评估非精原细胞性EGGCT二线化疗的结果，并试图确定生存的预后因素。
我们对1975年至1996年间在11个欧美中心接受治疗的142例患者进行了回顾性研究。所有患者均接受含顺铂方案作为诱导治疗。
142例患者中有27例（19%）长期无病生存，其中原发性纵隔肿瘤患者占11%，原发性腹膜后肿瘤患者占30%。所有患者自挽救治疗开始后的中位随访时间为11个月（范围1至157个月），存活患者为45个月（范围6至157个月）。48例患者（34%）在复发时接受了高剂量化疗及自体骨髓移植，其中10例患者（21%）持续无病生存。单因素分析显示，原发性纵隔肿瘤（P = 0.003）、对顺铂的敏感性（P = 0.003）、复发时β-HCG升高（P = 0.04）以及诊断时LDH正常（P = 0.01）是总生存的显著不良预后因素；多因素分析中，纵隔肿瘤[相对危险比（HR）= 1.9；95%置信区间（CI），1.2至3.0]和对顺铂的敏感性[HR = （此处原文可能有误，推测应为2.4）；95% CI，1.1至5.2]是显著不良预后因素。
尽管目前的挽救策略可使20%至50%的复发性转移性睾丸癌患者治愈，但复发性非精原细胞性EGGCT患者的生存率似乎较低，尤其是原发性纵隔肿瘤患者。纵隔原发性肿瘤和对基于顺铂的诱导化疗反应不佳已被确定为独立不良预后因素，两者均与挽救治疗失败风险高出约两倍相关。
