Rejlekova Katarina, Kalavska Katarina, Makovnik Marek, Hapakova Nikola, Chovanec Michal, De Angelis Valentina, Obertova Jana, Palacka Patrik, Sycova-Mila Zuzana, Mardiak Jozef, Mego Michal
2nd Department of Oncology, Faculty of Medicine, Comenius University and National Cancer Institute, Bratislava, Slovakia.
Oncology Department, National Cancer Institute, Bratislava, Slovakia.
Front Oncol. 2022 Jun 17;12:911879. doi: 10.3389/fonc.2022.911879. eCollection 2022.
Germ cell tumors (GCTs) represent a highly curable cancer. However, a small proportion of poor-risk patients can develop choriocarcinoma syndrome (CS) connected with acute respiratory distress syndrome (ARDS) with a high mortality rate. Our retrospective study aimed to determine the risk factors of poor-risk GCTs susceptible to CS development.
Using a computerized database and a systematic chart review, we identified the records of 532 patients with GCTs treated at the National Cancer Institute from 2000 to 2018. Ninety eligible patients with poor-risk GCTs based on IGCCCG classification were identified. All patients were treated with platinum-based induction chemotherapy. Clinicopathological variables were collected and analyzed in correlation with CS development.
Nine (10%) of 90 patients developed CS in a median of 1 day (1-9 days) after chemotherapy administration. All patients died shortly after the chemotherapy start with a median of 4 days (3-35 days) due to ARDS development. In univariate analysis, metastatic lung involvement ≥50% of lung parenchyma, choriocarcinoma elements in histology specimen, dyspnea, cough, hemoptysis, ECOG PS ≥2, weight loss, hemoglobin ≤100 g/l, and NLR ≥3.3 at the time of presentation were associated with CS development. In multivariate analysis, ECOG PS ≥2 and metastatic lung involvement ≥50% were independently associated with CS. All patients with these two characteristics developed CS, compared to 0% with zero or one of these factors (p < 0.000001).
In our study, we identified factors associated with CS development. These factors might improve the risk stratification of the patients susceptible to CS and improve their outcome.
生殖细胞肿瘤（GCTs）是一种治愈率很高的癌症。然而，一小部分高危患者可能会发生与急性呼吸窘迫综合征（ARDS）相关的绒毛膜癌综合征（CS），死亡率很高。我们的回顾性研究旨在确定易发生CS的高危GCTs的危险因素。
通过计算机数据库和系统的病历审查，我们确定了2000年至2018年在美国国立癌症研究所接受治疗的532例GCTs患者的记录。根据国际生殖细胞癌协作组（IGCCCG）分类，确定了90例高危GCTs合格患者。所有患者均接受铂类诱导化疗。收集临床病理变量并分析其与CS发生的相关性。
90例患者中有9例（10%）在化疗给药后中位1天（1 - 9天）发生CS。所有患者在化疗开始后不久因ARDS发展而死亡，中位时间为4天（3 - 35天）。单因素分析显示，就诊时肺实质转移受累≥50%、组织学标本中有绒毛膜癌成分、呼吸困难、咳嗽、咯血、东部肿瘤协作组（ECOG）体力状况评分≥2、体重减轻、血红蛋白≤100 g/l以及中性粒细胞与淋巴细胞比值（NLR）≥3.3与CS发生相关。多因素分析显示，ECOG PS≥2和肺转移受累≥50%与CS独立相关。具有这两个特征的所有患者均发生CS，而具有零个或一个这些因素的患者发生率为0%（p < 0.000001）。
在我们的研究中，我们确定了与CS发生相关的因素。这些因素可能会改善易发生CS患者的风险分层并改善其预后。
