Department of Clinical Pharmacology and Chemotherapy, N. N. Blokhin Russian Cancer Research Center, Moscow, Russia.
Urol Oncol. 2013 May;31(4):499-504. doi: 10.1016/j.urolonc.2011.06.001. Epub 2011 Jul 30.
Late relapses (>2 years) after completion of chemotherapy are rare and often platinum-resistant. There are limited data concerning late relapses in chemotherapy-naïve patients with stage I germ cell tumors. This retrospective analysis was performed to compare the outcome between patients with stage I germ cell tumors, who had late (≥2 years) and early (≥3 months and <2 years) relapse after orchiectomy.
We analyzed data of 1,069 chemotherapy-naïve patients with advanced germ cell tumors of testis treated in our department from 1986 to 2008. All patients had cisplatin- and etoposide-based chemotherapy. We identified 169 (15.8%) patients with prior stage I disease, who had not received adjuvant treatment: 140 and 29 patients had early and late relapse, respectively. Among patients with late relapse, pure seminoma was revealed in 14 patients, and nonseminoma in 15 patients. Median follow-up time for 169 patients was 35 (range, 2-218) months.
Patients with late relapse were older, 35 years (23-57) and had more frequent pure seminoma in primary tumor, 14/29 (48.3%), than patients with early relapse, 30 years (16-63) (P = 0.0008) and 46/140 (32,8%, P = 0.08), respectively. At the time of disease progression, both groups were very similar according to well-known prognostic factors including IGCCCG classification. The only difference was larger size of retroperitoneal lymph nodes in late (9 cm) than in early relapse (4 cm, P < 0.0001). The outcome in patients with late relapse was significantly worse than in patients with early relapse: complete response rate after induction chemotherapy was 20.7% (6/29) vs. 42.1% (59/140) (P = 0.01), 3-year progression-free survival 66% vs. 84% (P = 0.02, HR = 2.4, 95% CI 1.2-8.8) and 3-year overall survival, 72% vs. 88% (P = 0.04, HR = 2.4, 95% CI 1.05-10.25), respectively. In patients with pure seminoma, this difference in overall survival was even more significant: 65% vs. 91% (P = 0.04, HR = 3.8, 95% CI 1.06-32.4).
Late relapses following stage I germ cell tumors were associated with seminoma, older age, and worse outcome after induction chemotherapy.
化疗后 2 年以上的晚期复发（>2 年）罕见且通常对铂类耐药。关于化疗初治 I 期生殖细胞瘤患者的晚期复发数据有限。本回顾性分析旨在比较接受过顺铂和依托泊苷为基础的化疗的晚期（≥2 年）和早期（≥3 个月且<2 年）复发的 I 期生殖细胞肿瘤患者的结果。
我们分析了 1986 年至 2008 年期间在我们科室接受治疗的 1069 例晚期睾丸生殖细胞肿瘤的 169 例（15.8%）化疗初治患者的数据，所有患者均接受了顺铂和依托泊苷为基础的化疗。我们确定了 169 例先前患有 I 期疾病且未接受辅助治疗的患者：140 例患者为早期复发，29 例患者为晚期复发。晚期复发患者中，14 例为单纯精原细胞瘤，15 例为非精原细胞瘤。169 例患者的中位随访时间为 35 个月（范围，2-218 个月）。
晚期复发患者年龄较大，35 岁（23-57 岁），且原发肿瘤中纯精原细胞瘤更为常见，为 14/29（48.3%），而早期复发患者为 30 岁（16-63 岁）（P=0.0008）和 46/140（32.8%）（P=0.08）。在疾病进展时，根据国际生殖细胞肿瘤分类等公认的预后因素，两组非常相似。唯一的区别是晚期复发患者的腹膜后淋巴结更大（9cm），而早期复发患者为 4cm（P<0.0001）。晚期复发患者的预后明显差于早期复发患者：诱导化疗后的完全缓解率为 20.7%（6/29）vs. 42.1%（59/140）（P=0.01），3 年无进展生存率为 66% vs. 84%（P=0.02，HR=2.4，95%CI 1.2-8.8），3 年总生存率为 72% vs. 88%（P=0.04，HR=2.4，95%CI 1.05-10.25）。在单纯精原细胞瘤患者中，总生存率的差异更为显著：65% vs. 91%（P=0.04，HR=3.8，95%CI 1.06-32.4）。
I 期生殖细胞瘤患者的晚期复发与精原细胞瘤、年龄较大以及诱导化疗后的不良预后有关。
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