Department of Urology, Indiana University School of Medicine, Indiana University Melvin and Bren Simon Cancer Center, Indianapolis, Indiana.
Department of Urology, Indiana University School of Medicine, Indiana University Melvin and Bren Simon Cancer Center, Indianapolis, Indiana.
J Urol. 2015 Feb;193(2):507-12. doi: 10.1016/j.juro.2014.09.090. Epub 2014 Sep 22.
Induction chemotherapy for International Germ Cell Cancer Collaborative Group (IGCCCG) good risk metastatic testicular cancer includes 3 cycles of bleomycin, etoposide and cisplatin (BEP x3) or 4 cycles of etoposide and cisplatin (EP x4). We examine differences in active cancer in the retroperitoneum between patients receiving BEP x3 compared to EP x4.
The Indiana University Testis Cancer database was queried to identify IGCCCG good risk patients who received BEP x3 or EP x4 induction chemotherapy before retroperitoneal lymph node dissection. The primary outcome of interest was retroperitoneal histology. The association between the use of bleomycin in the induction regimen with active cancer in the retroperitoneal specimen was tested using a propensity score adjusted analysis.
A total of 179 men (79%) received BEP x3 while 47 (21%) received EP x4. Median age of the bleomycin, etoposide and cisplatin group was 27 years (range 15 to 50) vs 30 years (range 18 to 71) in the etoposide and cisplatin group. The incidence of active cancer in the retroperitoneal specimen at post-chemotherapy retroperitoneal lymph node dissection was significantly higher in the EP x4 group compared to the BEP x3 group (31.9% vs 7.8%, p <0.01). This significant difference in the bleomycin, etoposide and cisplatin vs etoposide and cisplatin groups remained in the propensity adjusted analysis (22.9% vs 7.8%, p=0.015).
There was a higher incidence of active cancer in the retroperitoneal specimen in good risk patients who received 4 cycles of induction etoposide and cisplatin chemotherapy compared to 3 cycles of bleomycin, etoposide and cisplatin in this retrospective analysis. The overall burden of treatment may be higher for men receiving EP x4 for induction chemotherapy.
国际生殖细胞癌协作组（IGCCCG）低危转移性睾丸癌的诱导化疗包括 3 个周期的博来霉素、依托泊苷和顺铂（BEP x3）或 4 个周期的依托泊苷和顺铂（EP x4）。我们研究了接受 BEP x3 与 EP x4 诱导化疗的患者腹膜后活性癌之间的差异。
印第安纳大学睾丸癌数据库被查询，以确定接受 BEP x3 或 EP x4 诱导化疗后行腹膜后淋巴结清扫术的 IGCCCG 低危患者。主要研究结果为腹膜后组织学。采用倾向评分调整分析，检测诱导方案中使用博来霉素与腹膜后标本中活性癌之间的关系。
共有 179 名男性（79%）接受了 BEP x3，47 名（21%）接受了 EP x4。博来霉素、依托泊苷和顺铂组的中位年龄为 27 岁（范围 15 至 50 岁），依托泊苷和顺铂组为 30 岁（范围 18 至 71 岁）。与 BEP x3 组相比，EP x4 组化疗后腹膜后淋巴结清扫术时腹膜后标本中活性癌的发生率明显更高（31.9% vs 7.8%，p<0.01）。在倾向评分调整分析中，博来霉素、依托泊苷和顺铂组与依托泊苷和顺铂组之间仍存在显著差异（22.9% vs 7.8%，p=0.015）。
在这项回顾性分析中，与接受 3 个周期博来霉素、依托泊苷和顺铂化疗的低危患者相比，接受 4 个周期依托泊苷和顺铂诱导化疗的低危患者腹膜后标本中活性癌的发生率更高。接受 EP x4 诱导化疗的男性总体治疗负担可能更高。
