Motzer R J, Geller N L, Tan C C, Herr H, Morse M, Fair W, Sheinfeld J, Sogani P, Russo P, Bosl G J
Department of Medicine, Memorial Sloan-Kettering Cancer Center, New York, New York.
Cancer. 1991 Mar 1;67(5):1305-10. doi: 10.1002/1097-0142(19910301)67:5<1305::aid-cncr2820670506>3.0.co;2-j.
Twenty-eight of 124 (23%) advanced germ cell tumor (GCT) patients who were treated on four successive platin-based induction regimens and who failed to achieve a durable complete response (CR) remain alive (median follow-up, 50 months). An analysis of prognostic factors for response and survival was conducted on the 94 patients who received salvage chemotherapy. Survival and/or response to salvage therapy were significantly enhanced for patients with a prior CR to induction chemotherapy, treatment with a cisplatin-based salvage regimen, a testis primary site, a normal serum human chorionic gonadotropin level, a normal serum lactate dehydrogenase level, one site of metastasis, and an Indiana Class of 6 or less. Patients with a prior incomplete response (IR) had a particularly poor prognosis (P = 0.00007) with only 4 of 52 (9%) patients alive (median follow-up, 37 months) compared with 15 of 42 (36%) patients with a prior best response of a CR (median follow-up, 35 months). The poor survival of patients who fail to achieve a durable CR to induction chemotherapy warrants the continued investigation of new salvage therapy. The identification of prognostic features may direct salvage therapy and aid in the interpretation of clinical trials of salvage regimens.
124例晚期生殖细胞肿瘤（GCT）患者接受了连续四种铂类诱导方案治疗，但未获得持久完全缓解（CR），其中28例（23%）仍存活（中位随访时间50个月）。对接受挽救性化疗的94例患者进行了反应和生存的预后因素分析。诱导化疗前达到CR、接受基于顺铂的挽救方案治疗、睾丸原发部位、血清人绒毛膜促性腺激素水平正常、血清乳酸脱氢酶水平正常、转移部位为一处以及印第安纳分级为6级或更低的患者，其生存和/或对挽救治疗的反应显著增强。诱导化疗前未达到完全缓解（IR）的患者预后特别差（P = 0.00007），52例患者中只有4例（9%）存活（中位随访时间37个月），而诱导化疗前最佳反应为CR的42例患者中有15例（36%）存活（中位随访时间35个月）。诱导化疗未能获得持久CR的患者生存情况较差，因此有必要继续研究新的挽救治疗方法。确定预后特征可能有助于指导挽救治疗，并有助于解释挽救方案的临床试验结果。
