Bhala N, Coleman J M, Radstone C R, Horsman J M, George J, Hancock B W, Hatton M Q, Coleman R E
Academic Unit of Clinical Oncology, Cancer Research Centre, Weston Park Hospital, Sheffield, UK.
Clin Oncol (R Coll Radiol). 2004 Feb;16(1):40-7. doi: 10.1016/s0936-6555(03)00166-3.
The survival of germ-cell tumours (GCT) was transformed after the introduction of cisplatin-based therapy. Previous trials have indicated BEP (bleomycin, etoposide and cisplatin) as the optimum treatment, although some centres including our own advocate the use of the alternating regimen POMB-ACE (cisplatin, vincristine, methotrexate, bleomycin and dactinomycin, cyclophosphamide and etoposide) for men with intermediate or poor prognosis disease. We analysed the survival and management of GCT patients treated at a specialist cancer centre in relation to internationally recognised prognostic groupings.
We retrieved patient information using the Trent Testicular Tumour Registry and supplemented it with information from patient notes. This included all patients with Royal Marsden Hospital Stage II, III and IV disease and patients with stage I disease at diagnosis with raised markers or subsequent relapse. We compared the efficacy and toxicity of the BEP and POMB-ACE chemotherapy regimens, and assessed relapse-free and overall survival.
We identified 178 non-seminomatous germ cell tumours (NSGCT) and 71 seminoma patients. Overall survival was similar to the International Germ Cell Cancer Collaborative Group (IGCCCG) classification for the good (95% vs 92%) and intermediate groups (82% vs 80%). The outcome for the poor prognosis group was better than expected in our series (57% vs 48%). There was a higher proportion of both immediate and late side-effects with POMB-ACE.
Survival and disease progression rates at this single institution were at least as good as reported by the IGCCCG and somewhat better for the poor-prognosis group. This may reflect use of the POMB-ACE chemotherapy regimen as opposed to standard BEP regimen. However, a randomised comparison of BEP and POMB-ACE would be required to validate this.
在引入以顺铂为基础的治疗方法后，生殖细胞肿瘤（GCT）患者的生存率得到了改善。以往的试验表明，博来霉素、依托泊苷和顺铂（BEP）方案是最佳治疗方案，不过包括我们中心在内的一些中心主张，对于预后中等或较差的男性患者，使用交替方案POMB - ACE（顺铂、长春新碱、甲氨蝶呤、博来霉素、放线菌素D、环磷酰胺和依托泊苷）。我们分析了在一家专业癌症中心接受治疗的GCT患者的生存情况及治疗管理，并与国际公认的预后分组进行了对比。
我们通过特伦特睾丸肿瘤登记处获取患者信息，并从患者病历中补充相关信息。这包括所有皇家马斯登医院II期、III期和IV期疾病患者，以及诊断时肿瘤标志物升高或随后复发的I期疾病患者。我们比较了BEP和POMB - ACE化疗方案的疗效和毒性，并评估了无复发生存率和总生存率。
我们确定了178例非精原细胞性生殖细胞肿瘤（NSGCT）患者和71例精原细胞瘤患者。总体生存率与国际生殖细胞癌协作组（IGCCCG）对良好预后组（95%对92%）和中等预后组（82%对80%）的分类相似。在我们的系列研究中，预后较差组的结果优于预期（57%对48%）。POMB - ACE方案的即刻和晚期副作用发生率都更高。
该单一机构的生存率和疾病进展率至少与IGCCCG报告的结果相当，对于预后较差组而言则稍好一些。这可能反映了使用POMB - ACE化疗方案而非标准的BEP方案。然而，需要对BEP和POMB - ACE进行随机对照比较来验证这一点。
