Division of Hematology & Medical Oncology, Department of Medicine, Indiana University School of Medicine, Indianapolis, USA.
Division of Hematology & Medical Oncology, Department of Medicine, Indiana University School of Medicine, Indianapolis, USA.
Ann Oncol. 2018 Feb 1;29(2):341-346. doi: 10.1093/annonc/mdx731.
To report our experience utilizing a multidisciplinary clinic (MDC) at Indiana University (IU) since the publication of the International Germ Cell Cancer Collaborative Group (IGCCCG), and to compare our overall survival (OS) to that of the National Cancer Institute (NCI) Surveillance, Epidemiology, and End Results (SEER) Program.
We conducted a retrospective analysis of all patients with metastatic germ-cell tumor (GCT) seen at IU from 1998 to 2014. A total of 1611 consecutive patients were identified, of whom 704 patients received an initial evaluation by our MDC (including medical oncology, pathology, urology and thoracic surgery) and started first-line chemotherapy at IU. These 704 patients were eligible for analysis. All patients in this cohort were treated with cisplatin-etoposide-based combination chemotherapy. We compared the progression-free survival (PFS) and OS of patients treated at IU with that of the published IGCCCG cohort. OS of the IU testis cancer primary cohort (n = 622) was further compared with the SEER data of 1283 patients labeled with 'distant' disease. The Kaplan-Meier method was used to estimate PFS and OS.
With a median follow-up of 4.4 years, patients with good, intermediate, and poor risk disease by IGCCCG criteria treated at IU had 5-year PFS of 90%, 84%, and 54% and 5-year OS of 97%, 92%, and 73%, respectively. The 5-year PFS for all patients in the IU cohort was 79% [95% confidence interval (CI) 76% to 82%]. The 5-year OS for the IU cohort was 90% (95% CI 87% to 92%). IU testis cohort had 5-year OS 94% (95% CI 91% to 96%) versus 75% (95% CI 73% to 78%) for the SEER 'distant' cohort between 2000 and 2014, P-value <0.0001.
The MDC approach to GCT at high-volume cancer center associated with improved OS outcomes in this contemporary dataset. OS is significantly higher in the IU cohort compared with the IGCCCG and SEER 'distant' cohort.
报告自国际生殖细胞癌协作组（IGCCCG）发表以来，印第安纳大学（IU）采用多学科诊疗模式（MDC）的经验，并将总生存（OS）与美国国家癌症研究所（NCI）监测、流行病学和最终结果（SEER）计划进行比较。
我们对 1998 年至 2014 年在 IU 就诊的所有转移性生殖细胞肿瘤（GCT）患者进行了回顾性分析。共确定了 1611 例连续患者，其中 704 例患者接受了我们的 MDC（包括肿瘤内科、病理科、泌尿科和胸外科）的初始评估，并在 IU 开始了一线化疗。这些 704 例患者符合分析条件。该队列中的所有患者均接受顺铂-依托泊苷联合化疗。我们比较了在 IU 治疗的患者的无进展生存期（PFS）和 OS，以及发表的 IGCCCG 队列。进一步比较了 IU 睾丸癌原发病例队列（n=622）与 SEER 数据中 1283 例“远处”疾病患者的 OS。Kaplan-Meier 法用于估计 PFS 和 OS。
中位随访 4.4 年后，按 IGCCCG 标准为低危、中危和高危疾病的患者在 IU 治疗的 5 年 PFS 分别为 90%、84%和 54%，5 年 OS 分别为 97%、92%和 73%。IU 队列中所有患者的 5 年 PFS 为 79%[95%可信区间（CI）76%至 82%]。IU 队列的 5 年 OS 为 90%（95%CI 87%至 92%）。2000 年至 2014 年，IU 睾丸癌队列的 5 年 OS 为 94%（95%CI 91%至 96%），而 SEER“远处”队列为 75%（95%CI 73%至 78%），P 值<0.0001。
在这个当代数据集，高容量癌症中心的 MDC 方法对 GCT 治疗与改善 OS 结果相关。与 IGCCCG 和 SEER“远处”队列相比，IU 队列的 OS 显著提高。
