Department of Oncology, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark; Unit of Survivorship, Danish Cancer Society Research Center, Danish Cancer Society, Copenhagen, Denmark.
Department of Oncology, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark.
Eur Urol. 2017 Feb;71(2):290-298. doi: 10.1016/j.eururo.2016.09.015. Epub 2016 Sep 17.
First-line treatment for patients with disseminated germ cell cancer (GCC) is bleomycin, etoposide, and cisplatin (BEP). A prognostic classification of patients receiving chemotherapy was published by the International Germ Cell Cancer Collaborative Group (IGCCCG) in 1997, but only a small proportion of the patients received BEP.
To estimate survival probabilities after BEP, evaluate the IGCCCG prognostic classification, and propose new prognostic factors for outcome.
DESIGN, SETTING, AND PARTICIPANTS: Of a Danish population-based cohort of GCC patients (1984-2007), 1889 received first-line BEP, with median follow-up of 15 yr. Covariates evaluated as prognostic factors were age, year of treatment, primary site, non-pulmonary visceral metastases, pulmonary metastases, and tumor markers.
Outcomes measured were 5-yr progression-free survival (PFS), 5-yr disease-specific survival (DSS), and 5-yr overall survival (OS) as calculated using the Kaplan-Meier method and the Cox proportional hazards model.
The 5-yr PFS, DSS, and OS were 87%, 95%, and 93%, respectively, for patients with seminomatous GCC (SGCC) and good prognosis. For nonseminomatous GCC (NSGCC) with good, intermediate, and poor prognosis, the 5-yr probabilities were 90%, 76%, and 55% for PFS; 97%, 87%, and 66% for DSS; and 95%, 85%, and 64% for OS, respectively. For SGCC patients, new adverse prognostic factors not included in the IGCCCG classification were higher age and lactate dehydrogenase ≥1.5 times the upper limit of normal. For NSGCC patients, higher age and pulmonary metastases were additional adverse prognostic factors. Treatment in earlier years was associated with higher mortality. Limitations include the small number of patients in the prognostic groups, and the inability to adjust for performance status and comorbidity.
Our study reveals improved survival for disseminated GCC throughout the study period. We propose new prognostic factors for outcome for validation in larger cohorts of patients.
In this study of testicular cancer patients, we evaluated prognostic factors for outcome and calculated survival after standard chemotherapy. We find that survival has improved over the years and we propose new prognostic factors for outcome for validation in larger patient cohorts.
博来霉素、依托泊苷和顺铂（BEP）是治疗播散性生殖细胞癌（GCC）患者的一线治疗药物。1997 年，国际生殖细胞癌协作组（IGCCCG）公布了患者接受化疗的预后分类，但只有一小部分患者接受了 BEP 治疗。
估计 BEP 治疗后的生存率，评估 IGCCCG 预后分类，并提出新的预后因素。
设计、地点和参与者：在丹麦基于人群的 GCC 患者队列（1984-2007 年）中，1889 名患者接受了一线 BEP 治疗，中位随访时间为 15 年。评估为预后因素的协变量包括年龄、治疗年份、原发部位、非肺部内脏转移、肺部转移和肿瘤标志物。
使用 Kaplan-Meier 方法和 Cox 比例风险模型计算的结果测量包括 5 年无进展生存率（PFS）、5 年疾病特异性生存率（DSS）和 5 年总生存率（OS）。
精原细胞瘤（SGCC）且预后良好的患者 5 年 PFS、DSS 和 OS 分别为 87%、95%和 93%。非精原细胞瘤（NSGCC）且预后良好、中等和差的患者 5 年 PFS 概率分别为 90%、76%和 55%；DSS 分别为 97%、87%和 66%；OS 分别为 95%、85%和 64%。对于 SGCC 患者，IGCCCG 分类中未包括的新不良预后因素为年龄较高和乳酸脱氢酶（LDH）≥正常上限的 1.5 倍。对于 NSGCC 患者，年龄较高和肺部转移是另外的不良预后因素。较早年份的治疗与死亡率较高相关。局限性包括预后组患者数量较少，以及无法调整体能状态和合并症。
本研究显示，整个研究期间，播散性 GCC 的生存率有所提高。我们提出了新的预后因素，以验证更大患者队列的结果。
在这项睾丸癌患者的研究中，我们评估了预后因素和标准化疗后的生存情况。我们发现，随着时间的推移，生存率有所提高，我们提出了新的预后因素，以验证更大的患者队列的结果。
