Department of Cancer Medicine, University of Paris Sud, Institut Gustave Roussy, Villejuif, France.
Department of Urology, Saint-Joseph Hospital, Paris, France.
Eur J Cancer. 2014 May;50(7):1284-90. doi: 10.1016/j.ejca.2014.01.026. Epub 2014 Feb 20.
To evaluate prior compliance with guidelines in patients treated with salvage chemotherapy for advanced germ-cell tumours (GCT).
Data concerning the initial management of patients requiring salvage chemotherapy for GCT at Institut Gustave Roussy between 2000 and 2010 were obtained and correlated with recommendations for treatment. Criteria of non-compliance were defined based on guidelines. Compliance with guidelines, predictive factors for non-compliance and the impact on outcome were analysed.
Among 82 patients treated in the salvage setting, guidelines to initial treatment were followed in only 41 cases (50%). The most common non-compliance criteria were non-adherence to the planned dose (16%), an inappropriate interval between first-line chemotherapy cycles (16%), the lack of post-chemotherapy surgery (16%) and a long interval to post-chemotherapy surgery (48%). Compliance with standard care was better in cancer centres than in other hospitals (private or public) (Odd Ratio (OR): 6.9, P = 0.001). A poor-risk status according to the International Germ Cell Cancer Collaborative Group (IGCCCG) was also predictive of compliance in univariate but not in multivariate analysis. No significant difference in outcome after salvage chemotherapy was observed. Patients relapsing after non-compliant first-line therapy tended to be more easily salvaged, which is consistent with the fact that their initial treatment was inadequate. Some of these relapses were therefore probably not due to true biologically refractory disease.
Guidelines for first-line treatment are adhered to in only half the patients requiring salvage chemotherapy. As the only predictive factor for non-compliance was the treating centre, centralisation of patients with GCT in well-trained hospitals should be recommended.
评估晚期生殖细胞瘤（GCT）患者接受挽救性化疗时先前对指南的遵循情况。
获取 2000 年至 2010 年期间 Institut Gustave Roussy 接受挽救性化疗的 GCT 患者初始治疗数据，并与治疗建议相关联。根据指南定义不符合标准的条件。分析符合指南、不符合指南的预测因素以及对结果的影响。
在 82 例挽救性治疗的患者中，仅有 41 例（50%）遵循了初始治疗指南。最常见的不符合标准的条件是未遵循计划剂量（16%）、一线化疗周期之间的间隔不合适（16%）、缺乏化疗后手术（16%）以及化疗后手术间隔时间长（48%）。与其他医院（私立或公立）相比，癌症中心更符合标准护理（Odd Ratio（OR）：6.9，P = 0.001）。根据国际生殖细胞瘤癌症协作组（IGCCCG）的不良风险状态也是单变量分析中符合条件的预测因素，但在多变量分析中不是。挽救性化疗后的结果无显著差异。不符合一线治疗标准的患者复发后更容易被挽救，这与他们的初始治疗不足的事实相符。这些复发中的一些可能并非真正的生物学难治性疾病所致。
仅一半需要挽救性化疗的患者遵循一线治疗指南。由于唯一的不符合标准的预测因素是治疗中心，因此应推荐将 GCT 患者集中在训练有素的医院中。
