Department of Clinical Pharmacology and Chemotherapy, N.N. Blokhin Russian Cancer Research Center, 24 Kashirskoye Shosse, 115478, Moscow, Russia,
J Cancer Res Clin Oncol. 2014 Feb;140(2):311-8. doi: 10.1007/s00432-013-1567-1. Epub 2013 Dec 17.
Patients (pts) with mediastinal nonseminomatous germ cell tumors (MNGCT) are belonged to poor prognostic group by IGCCCG. We retrospectively studied the prognostic factors and efficacy of different chemotherapeutic regimen in pts with MNGCT.
We analyzed data on 61 pts with MNGCT. Conditional induction chemotherapy BEP was performed in 38 %, TBEP-in 28 %, CBOP-in 28 %, accelerated (two weekly) version of BEP-in 6 % pts. Based on similar efficacy of CBOP and TBEP regimens, we combines pts with CPOB and TBEP regimen in one group-55.8 % and different variants of BEP regimen in the second group-44.2 %. Multivariate Cox regression analysis was performed to determine independent factors, which influenced on overall survival.
We revealed the following independent negative prognostic factors: age ≥ 24 years (p = 0.07), size of the primary mediastinal tumor ≥19 cm (p = 0.03). Median overall survival (OS) has not been reached, and 2-year OS was 66 % in pts with good prognosis (age < 24 years and/or size of mediastinal tumor < 19 cm) versus 15 months and 40 % in pts with poor prognosis (p = 0.03). Objective marker negative response was revealed more often in pts with CPOB/TBEP group: 26/34 (76.5 %) versus 14/27 (52 %), p = 0.08. Median OS was also higher in pts with CPOB/TBEP group: nonreached versus 15 months (p = 0.01).
CPOB and TBEP regimen were significantly associated with better outcome in pts with MNGCT. Age ≥ 24 years and size of the primary mediastinal tumor ≥ 19 cm were found as independent negative prognostic factors.
国际生殖细胞肿瘤协作组（IGCCCG）将纵隔非精原细胞瘤生殖细胞肿瘤（MNGCT）患者归为预后不良组。我们回顾性研究了 MNGCT 患者不同化疗方案的预后因素和疗效。
我们分析了 61 例 MNGCT 患者的数据。38%的患者接受了条件诱导化疗 BEP，28%的患者接受了 TBEP，28%的患者接受了 CBOP，6%的患者接受了加速（每周两次）BEP。基于 CBOP 和 TBEP 方案疗效相似，我们将 CPOB 和 TBEP 方案的患者合并为一组（55.8%），将不同的 BEP 方案合并为一组（44.2%）。多变量 Cox 回归分析确定影响总生存的独立因素。
我们发现了以下独立的负预后因素：年龄≥24 岁（p=0.07），纵隔原发肿瘤大小≥19cm（p=0.03）。中位总生存期（OS）未达到，预后良好（年龄<24 岁和/或纵隔肿瘤大小<19cm）患者的 2 年 OS 为 66%，而预后不良（年龄≥24 岁和/或纵隔肿瘤大小≥19cm）患者的 2 年 OS 为 15 个月和 40%（p=0.03）。CPOB/TBEP 组客观标记物阴性反应更为常见：34/34（76.5%）比 27/27（52%），p=0.08。CPOB/TBEP 组的中位 OS 也更高：未达到与 15 个月（p=0.01）。
CPOB 和 TBEP 方案与 MNGCT 患者的更好结局显著相关。年龄≥24 岁和纵隔原发肿瘤大小≥19cm 是独立的负预后因素。
