Berger Lars Arne, Bokemeyer Carsten, Lorch Anja, Hentrich Marcus, Kopp Hans-Georg, Gauler Thomas Christoph, Beyer Jörg, de Wit Maike, Mayer Frank, Boehlke Ina, Oing Christoph, Honecker Friedemann, Oechsle Karin
Department of Oncology, Hematology, BMT with Section of Pneumology, University Medical Center Hamburg-Eppendorf, Martinistr. 52, 20246, Hamburg, Germany,
J Cancer Res Clin Oncol. 2014 Jul;140(7):1211-20. doi: 10.1007/s00432-014-1661-z. Epub 2014 Apr 3.
We analyzed prognostic categories at first relapse according to the International Prognostic Factors Study Group (IPFSG) criteria as well as the efficacy of salvage treatment.
143 patients with relapsed or refractory germ cell cancer undergoing first salvage treatment with conventional-dose (CD-CX, n = 48) or high-dose chemotherapy with autologous stem cell support (HD-CX, n = 95) contributed by nine centers were retrospectively analyzed.
Prognostic subgroups according to IPFSG criteria were: very low risk 13/143, low risk 36/143, intermediate risk 66/143, high risk 22/143, and very high risk 6/143 patients. The IPFSG categories significantly correlated with overall survival (OS) (p = 0.025) after 1st salvage treatment. After a median follow-up of 19 months, 55 % of all patients had relapsed and 33 % had died. For the entire cohort, progression-free survival (PFS) rate after 2 years was 43 %, and OS rate after 5 years was 52 %. Compared to the HD-CX group, vital carcinoma was found more often in secondarily resected lesions following CD-CX (22/29 vs. 22/45; p = 0.021). Second relapse rate was higher with 75 versus 44 %, resulting in a shorter median PFS with 8 versus 42 months (p < 0.001), but this did not translate into different OS (p = 0.931). At subsequent relapses, 26/36 patients received HD-CX as ≥2nd-salvage treatment.
This analysis confirms the prognostic value of the IPFSG prognostic score. HD-CX seemed superior to CD-CX as first salvage treatment with respect to PFS in this retrospective analysis.
我们根据国际预后因素研究组（IPFSG）标准分析了首次复发时的预后类别以及挽救治疗的疗效。
对9个中心提供的143例复发或难治性生殖细胞癌患者进行回顾性分析，这些患者接受了首次挽救治疗，其中48例采用常规剂量化疗（CD-CX），95例采用高剂量化疗联合自体干细胞支持（HD-CX）。
根据IPFSG标准划分的预后亚组为：极低风险13/143例、低风险36/143例、中风险66/143例、高风险22/143例、极高风险6/143例患者。IPFSG类别与首次挽救治疗后的总生存期（OS）显著相关（p = 0.025）。中位随访19个月后，所有患者中有55%复发，33%死亡。对于整个队列，2年无进展生存期（PFS）率为43%，5年OS率为52%。与HD-CX组相比，CD-CX后二次切除病变中活癌的发现更为常见（22/29 vs. 22/45；p = 0.021）。二次复发率较高，分别为75%和44%，导致中位PFS较短，分别为8个月和42个月（p < 0.001），但这并未转化为不同的OS（p = 0.931）。在随后的复发中，26/36例患者接受HD-CX作为≥第二次挽救治疗。
该分析证实了IPFSG预后评分的预后价值。在这项回顾性分析中，就PFS而言，HD-CX作为首次挽救治疗似乎优于CD-CX。
