Department of Cancer Medicine, Institut Gustave Roussy, Villejuif, France.
Department of Medical Oncology, Centre Paul Papin, Angers, France.
Eur Urol. 2014 Feb;65(2):381-6. doi: 10.1016/j.eururo.2013.09.004. Epub 2013 Sep 13.
Whether patients with good prognosis and intermediate/poor prognosis advanced seminoma should be treated differently has not been defined.
To assess a risk-adapted chemotherapy regimen in patients with advanced seminoma.
DESIGN, SETTING, AND PARTICIPANTS: A total of 132 patients were included in this prospective study. Patients with a good prognosis according to the International Germ Cell Cancer Collaboration Group (IGGCCG) were treated with four cycles of cisplatin-etoposide (EP). Patients with an intermediate prognosis according to the IGCCCG (or a poor prognosis according to the Medical Research Council classification) were treated with four cycles of VIP (EP and ifosfamide) and granulocyte colony-stimulating factor (G-CSF).
Survival curves were estimated using the Kaplan-Meier method.
The median follow-up was 4.5 yr (range: 0.4-11.6 yr). Among 108 patients (82%) with a good prognosis who received EP, grade 3-4 toxicity included neutropenia (47%) and neutropenic fever (12%). Among the 24 patients (18%) with an intermediate/poor prognosis who received VIP plus G-CSF, toxicity included grade 3-4 neutropenia (36%), neutropenic fever (23%), thrombocytopenia (23%), anemia (23%), and a toxicity-related death (n=1; 4%). The 3-yr progression-free survival (PFS) rate was 93% (range: 85-97%) in the good prognosis group and 83% (range: 63-93%) in the intermediate/poor prognosis group (p=0.03 for PFS). The 3-yr overall survival (OS) rate was 99% (range: 92-100%) and 87% (range: 67-95%), respectively (p<0.005 for OS). Only four patients died of seminoma or its treatment.
A risk-adapted chemotherapy policy for advanced seminoma yielded an excellent outcome with a 3-yr OS rate of 96%.
预后良好和中/差预后的晚期精原细胞瘤患者是否应采用不同的治疗方法尚未明确。
评估晚期精原细胞瘤患者的风险适应化疗方案。
设计、地点和参与者：这项前瞻性研究共纳入了 132 例患者。根据国际生殖细胞癌协作组（IGGCCG）预后良好的患者接受 4 个周期顺铂-依托泊苷（EP）治疗。根据 IGGGCCG 预后中等（或根据医学研究委员会分类预后较差）的患者接受 4 个周期 VIP（EP 和异环磷酰胺）和粒细胞集落刺激因子（G-CSF）治疗。
使用 Kaplan-Meier 法估计生存曲线。
中位随访时间为 4.5 年（范围：0.4-11.6 年）。在接受 EP 治疗的 108 例（82%）预后良好的患者中，3-4 级毒性包括中性粒细胞减少症（47%）和中性粒细胞减少症发热（12%）。在接受 VIP 加 G-CSF 治疗的 24 例（18%）中/预后不良的患者中，毒性包括 3-4 级中性粒细胞减少症（36%）、中性粒细胞减少症发热（23%）、血小板减少症（23%）、贫血（23%）和与毒性相关的死亡（n=1；4%）。在预后良好的组中，3 年无进展生存率（PFS）为 93%（范围：85-97%），在中/预后不良的组中为 83%（范围：63-93%）（PFS 为 0.03）。3 年总生存率（OS）分别为 99%（范围：92-100%）和 87%（范围：67-95%）（OS 为<0.005）。只有 4 例患者死于精原细胞瘤或其治疗。
晚期精原细胞瘤的风险适应化疗方案获得了极好的结果，3 年 OS 率为 96%。
