Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada.
Institute for Medical Research, University of Leeds, Leeds, United Kingdom.
Cancer. 2021 Jan 15;127(2):193-202. doi: 10.1002/cncr.33273. Epub 2020 Oct 20.
Adolescents with extracranial metastatic germ cell tumors (GCTs) are often treated with regimens developed for children, but their clinical characteristics more closely resemble those of young adult patients. This study was designed to determine event-free survival (EFS) for adolescents with GCTs and compared them with children and young adults.
An individual patient database of 11 GCT trials was assembled: 8 conducted by pediatric cooperative groups and 3 conducted by an adult group. Male patients aged 0 to 30 years with metastatic, nonseminomatous, malignant GCTs of the testis, retroperitoneum, or mediastinum who were treated with platinum-based chemotherapy were included. The age groups were categorized as children (0 to <11 years), adolescents (11 to <18 years), and young adults (18 to ≤30 years). The study compared EFS and adjusted for risk group by using Cox proportional hazards analysis.
From a total of 2024 individual records, 593 patients met the inclusion criteria: 90 were children, 109 were adolescents, and 394 were young adults. The 5-year EFS rate was lower for adolescents (72%; 95% confidence interval [CI], 62%-79%) than children (90%; 95% CI, 81%-95%; P = .003) or young adults (88%; 95% CI, 84%-91%; P = .0002). The International Germ Cell Cancer Collaborative Group risk group was associated with EFS in the adolescent age group (P = .0020). After adjustments for risk group, the difference in EFS between adolescents and children remained significant (hazard ratio, 0.30; P = .001).
EFS for adolescent patients with metastatic GCTs was similar to that for young adults but significantly worse than for that children. This finding highlights the importance of coordinating initiatives across clinical trial organizations to improve outcomes for adolescents and young adults.
Adolescent males with metastatic germ cell tumors (GCTs) are frequently treated with regimens developed for children. In this study, a large data set of male patients with metastatic GCTs across different age groups has been built to understand the outcomes of adolescent patients in comparison with children and young adults. The results suggest that adolescent males with metastatic GCTs have worse results than children and are more similar to young adults with GCTs. Therefore, the treatment of adolescents with GCTs should resemble therapeutic approaches for young adults.
患有颅外转移性生殖细胞肿瘤（GCT）的青少年通常接受为儿童开发的治疗方案，但他们的临床特征更类似于年轻成年患者。本研究旨在确定患有 GCT 的青少年的无事件生存（EFS）率，并将其与儿童和年轻成人进行比较。
我们组建了一个包含 11 项 GCT 试验的个体患者数据库：8 项由儿科合作组开展，3 项由成人组开展。纳入标准为患有睾丸、腹膜后或纵隔的转移性、非精原细胞性、恶性 GCT 的 0 至 30 岁男性患者，他们接受了基于铂类的化疗。年龄组分为儿童（0 至＜11 岁）、青少年（11 至＜18 岁）和年轻成人（18 至≤30 岁）。该研究通过 Cox 比例风险分析比较了无事件生存率（EFS）并对风险组进行了调整。
在总共 2024 条单独记录中，有 593 名患者符合纳入标准：90 名儿童、109 名青少年和 394 名年轻成人。青少年（72%；95%置信区间[CI]，62%-79%）的 5 年 EFS 率低于儿童（90%；95%CI，81%-95%；P=.003）或年轻成人（88%；95%CI，84%-91%；P=.0002）。国际生殖细胞癌协作组（International Germ Cell Cancer Collaborative Group）风险组与青少年年龄组的 EFS 相关（P=.0020）。在校正风险组后，青少年与儿童之间的 EFS 差异仍具有统计学意义（风险比，0.30；P=.001）。
患有转移性 GCT 的青少年患者的 EFS 与年轻成人相似，但明显差于儿童。这一发现强调了协调临床试验组织之间的举措以改善青少年和年轻成人结局的重要性。
患有转移性生殖细胞肿瘤（GCT）的青少年男性常接受为儿童制定的治疗方案。在这项研究中，建立了一个包含不同年龄组男性转移性 GCT 患者的大型数据集，以了解与儿童和年轻成人相比，青少年患者的结局。结果表明，患有转移性 GCT 的青少年男性的结果比儿童差，与 GCT 年轻成人更相似。因此，治疗患有 GCT 的青少年应类似于年轻成人的治疗方法。
