National Institute of Oncology, Budapest, Hungary.
National Institute of Oncology, Budapest, Hungary.
Curr Probl Cancer. 2020 Aug;44(4):100537. doi: 10.1016/j.currproblcancer.2020.100537. Epub 2020 Jan 16.
To obtain information on outcome stratified by histology, extent and primary treatment patients' data with primary malignant mediastinal germ cell tumors treated between 1998 and 2018 were retrospectively analyzed.
The primary treatment for localized malignant mediastinal germ cell tumors was neoadjuvant bleomycin + etoposid + cisplatin (BEP) ± surgery (n = 22); or surgery ± adjuvant BEP (n = 16). For disseminated disease (n = 21) first line BEP ± second line chemotherapy were administered. For nonseminomas (NS) the NLR at start of BEP was analyzed in relation to disease-free survival (DFS), progression-free survival (PFS), and overall survival (OS).
After neoadjuvant treatment the 5-year DFS was 100% for seminomas (S), and 63.4% for NS. The 5-year OS was 100% for S, and 76.9% for NS. The 5-year DFS and OS after surgery ± BEP for S was 72.9% and 100%, for NS was 75% and 87.5%, respectively. The 5-year PFS and OS of metastatic patients for S was 60% and 80%, while the median PFS and OS of NS were 5.7 and 11.1 months, respectively. Objective response (P = 0.006) and low NLR (P = 0.043) were independent prognostic markers of longer OS.
We confirmed the good outcome of BEP-treated S, while NS had poorer prognosis. Previously published prognostic models for NS were validated. Based on NLR and response a new prognostic model was developed.
通过回顾性分析 1998 年至 2018 年间接受治疗的原发性恶性纵隔生殖细胞肿瘤患者的组织学、范围和主要治疗方法的数据，获得其预后分层信息。
局限性恶性纵隔生殖细胞肿瘤的主要治疗方法为新辅助博来霉素+依托泊苷+顺铂（BEP）±手术（n=22）；或手术±辅助 BEP（n=16）。对于播散性疾病（n=21），给予一线 BEP±二线化疗。对于非精原细胞瘤（NS），在开始 BEP 时分析中性粒细胞与淋巴细胞比值（NLR）与无疾病生存（DFS）、无进展生存（PFS）和总生存（OS）的关系。
新辅助治疗后，精原细胞瘤（S）的 5 年 DFS 为 100%，NS 为 63.4%。S 的 5 年 OS 为 100%，NS 为 76.9%。S 接受手术±BEP 治疗的 5 年 DFS 和 OS 分别为 72.9%和 100%，NS 为 75%和 87.5%。S 转移性患者的 5 年 PFS 和 OS 分别为 60%和 80%，而 NS 的中位 PFS 和 OS 分别为 5.7 和 11.1 个月。客观缓解（P=0.006）和低 NLR（P=0.043）是 OS 更长的独立预后标志物。
我们证实了 BEP 治疗 S 的良好预后，而 NS 的预后较差。验证了先前发表的 NS 预后模型。根据 NLR 和反应建立了新的预后模型。
