Department of Oncology, Hematology and Bone Marrow Transplantation with Section of Pneumology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.
Department of Oncology, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark.
Eur J Cancer. 2018 May;94:16-25. doi: 10.1016/j.ejca.2018.01.113. Epub 2018 Mar 20.
For metastatic germ cell tumour patients with intermediate prognosis (IPGCT) according to the IGCCCG classification 5-year overall survival (OS) rates of 79% were described, but recent data suggest significant changes.
To compare the outcome of current IPGCT with former patients and to find new prognosticators a retrospective observational study was performed. Eligibility criteria were: age ≥16 years, diagnosed between 1979 and 2014. Primary end-point was the 5-year OS rate.
This database includes 707 IPGCT: group 1 was diagnosed 1979-1996 (n = 237), and group 2 1997-2014 (n = 470). Median follow-up was 8.6 years (IQR: 14.4). Group 1 and 2 received first-line treatment with BEP (median 4 cycles; range 1-6) in 99% (group 1) and 95% (group 2), respectively. The proportion of first-line chemotherapy responders (CR and marker negative PR) was similar: 94% (group 1) and 96% (group 2), respectively (P = 0.290), but OS was superior in group 2 with a 5-year OS rate of 89% compared with 83% in group 1 (P = 0.035). In refractory disease, high-dose chemotherapy and treatment beyond second line was performed more often in group 2. A lactate dehydrogenase (LDH) cut-off value of 2 ULN (P = 0.002; HR 2.121) and alpha-fetoprotein (AFP) levels of 6200 IU/ml (P = 0.032; HR 2.155) pre-chemotherapy were independent prognosticators for OS in a multivariate analysis.
Outcome of IPGCT has improved and is now closer to the good prognosis category. LDH and AFP levels represent potential markers to stratify IPGCT before treatment initiation.
根据 IGCCCG 分类，转移性生殖细胞肿瘤（mGCT）伴中危预后（IPGCT）患者的 5 年总生存率（OS）为 79%，但最近的数据表明情况发生了显著变化。
为了比较当前 IPGCT 患者与既往患者的预后，并寻找新的预后标志物，我们进行了一项回顾性观察研究。入选标准为：年龄≥16 岁，1979 年至 2014 年期间诊断。主要终点为 5 年 OS 率。
该数据库纳入了 707 例 IPGCT 患者：第 1 组诊断时间为 1979 年至 1996 年（n=237），第 2 组为 1997 年至 2014 年（n=470）。中位随访时间为 8.6 年（IQR：14.4）。第 1 组和第 2 组分别有 99%（第 1 组）和 95%（第 2 组）的患者接受了一线 BEP 治疗（中位数 4 个周期；范围 1-6）。一线化疗应答者（CR 和标志物阴性 PR）的比例相似：第 1 组为 94%，第 2 组为 96%（P=0.290），但第 2 组的 OS 更好，5 年 OS 率为 89%，而第 1 组为 83%（P=0.035）。在难治性疾病中，第 2 组更常进行大剂量化疗和二线以上治疗。多变量分析显示，治疗前乳酸脱氢酶（LDH）值>2ULN（P=0.002；HR 2.121）和甲胎蛋白（AFP）水平>6200IU/ml（P=0.032；HR 2.155）是 OS 的独立预后因素。
IPGCT 的预后已得到改善，现在更接近预后良好的类别。LDH 和 AFP 水平是治疗前分层 IPGCT 的潜在标志物。
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