James Buchanan Brady Urological Institute and Department of Urology, Johns Hopkins University School of Medicine, Baltimore, Maryland.
Department of Urology, University of Texas Southwestern, Dallas, Texas.
Cancer. 2019 Nov 15;125(22):3947-3952. doi: 10.1002/cncr.32427. Epub 2019 Jul 29.
Using a large, nationally representative, population-based cancer registry, this study systematically evaluated the impact of the location and burden of extranodal testicular germ cell tumor (TGCT) metastases on survival.
Men with stage III TGCTs captured by the Surveillance, Epidemiology, and End Results registry from 2010 to 2015 with distant extranodal metastases were identified. Clinicopathologic information was collected, and patients were subdivided according to the specific organ site or sites of metastatic involvement (lung, liver, bone, and/or brain). Kaplan-Meier analysis and multivariable Cox regression were used to evaluate cancer-specific survival (CSS), and model performance was assessed with Harrell's C statistic.
Nine hundred sixty-nine patients with stage III TGCTs were included with predominantly nonseminomatous histology (84%). Most patients (91%) had pulmonary metastases, whereas 20%, 10%, and 10% had liver, bone, and brain metastases, respectively. Over a median follow-up of 21 months, 19% of these men died of TGCTs. When they were grouped by the primary site of metastasis, patients with more than 1 extrapulmonary metastasis exhibited the worst CSS (hazard ratio [HR] vs isolated pulmonary involvement, 4.27; 95% confidence interval [CI], 2.60-7.00; P < .01). Among patients with isolated extrapulmonary involvement, those with brain metastases had the poorest survival (HR, 3.24; 95% CI, 1.98-5.28; P < .01), and they were followed by patients with liver (HR, 2.29; 95% CI, 1.56-3.35; P < .01) and bone metastases (HR, 1.97; 95% CI, 1.11-3.50; P = .02). Harrell's C statistic (multivariable) was 0.71.
The site of metastatic involvement affects survival outcomes for patients with TGCTs, and this may reflect both the aggressive biology and the challenging treatment of these tumors. Further incorporation of organotropism into current prognostic models for metastatic TGCTs warrants attention.
本研究利用大型、具有全国代表性的癌症登记处，系统评估了睾丸生殖细胞肿瘤（TGCT）结外转移的部位和负担对生存的影响。
从 2010 年至 2015 年，通过监测、流行病学和最终结果登记处捕获的患有 III 期 TGCT 且伴有远处结外转移的男性被确定为研究对象。收集临床病理信息，并根据转移性受累的特定器官部位或部位（肺、肝、骨和/或脑）对患者进行细分。Kaplan-Meier 分析和多变量 Cox 回归用于评估癌症特异性生存率（CSS），并使用 Harrell 的 C 统计评估模型性能。
纳入了 969 名患有 III 期 TGCT 的患者，其中主要为非精原细胞瘤组织学（84%）。大多数患者（91%）有肺部转移，而分别有 20%、10%和 10%的患者有肝、骨和脑转移。在中位数为 21 个月的随访中，这些男性中有 19%死于 TGCT。当按转移的主要部位进行分组时，转移灶多于 1 个的患者 CSS 最差（与孤立性肺受累相比，风险比 [HR]为 4.27；95%置信区间 [CI]为 2.60-7.00；P<.01）。在孤立性肺外受累的患者中，有脑转移的患者生存最差（HR，3.24；95%CI，1.98-5.28；P<.01），其次是有肝转移的患者（HR，2.29；95%CI，1.56-3.35；P<.01）和骨转移的患者（HR，1.97；95%CI，1.11-3.50；P=.02）。多变量的 Harrell 的 C 统计量（multivariable）为 0.71。
转移部位影响 TGCT 患者的生存结果，这可能反映了这些肿瘤的侵袭性生物学和挑战性治疗。进一步将器官嗜性纳入转移性 TGCT 目前的预后模型值得关注。
