Zhang Hanbo, Alimohamed Nimira S, Basappa Naveen S, Cheng Tina, Chu Michael, Cox-Kennett Nanette, Ernst D Scott, Fontaine Amelie, Ghosh Sunita, Heng Daniel Y C, Littleton Richard, North Scott, Railton Cindy, Sandhu Irwindeep, Stenson Trevor H, Stewart Douglas A, Venner Christopher P, Venner Peter, Kolinsky Michael P
Department of Medical Oncology and Hematology, University of Manitoba, Winnipeg, MB, Canada.
Department of Oncology, University of Calgary, Calgary, AB, Canada.
Can Urol Assoc J. 2024 Mar;18(3):E73-E79. doi: 10.5489/cuaj.8493.
High-dose chemotherapy with autologous stem-cell transplantation (HDC-ASCT) is standard therapy for metastatic germ cell tumors (mGCTs) in patients whose disease progresses during or after conventional chemotherapy. We conducted a retrospective review of HDC-ASCT in relapsed mGCT patients in the province of Alberta, Canada, over the past two decades.
Patients with mGCTs who received HDC-ASCT at two provincial cancer referral centers from 2000-2018 were identified from institutional databases. Baseline clinical and treatment characteristics were collected, as well as overall survival (OS ) and disease-free survival (DFS). Relevant prognostic variables were analyzed.
Forty-three patients were identified. The median age was 28 years (range 19-56). A majority (95%) had non-seminoma histology and testis/retroperitoneal primary (84%). Twenty patients (47%) had poor-risk disease, as per The International Germ Cell Consensus Classification (IGCCC), at start of first-line chemotherapy. HDC-ASCT was used as second-line therapy in 65% of patients, and 58% of ASCT patients received tandem transplants. Median followup after ASCT was 22 months (range 2-181). At last followup, 42% of patients were alive without disease, including 3/7 (43%) of patients with primary mediastinal disease. Two-year and five-year DFS/OS ratios were 44%/65% and 38%/45%, respectively. Median OS and DFS for all patients were 30.0 months (13.3-46.6) and 8.0 months (0.9-15.1), respectively.
We found that HDC-ASCT is an effective salvage therapy in mGCT, consistent with existing literature. Patients appeared to benefit regardless of primary site. Although limited by small sample size, we found a numerical difference in DFS and OS between second- and third-line HDC-ASCT and single vs. tandem ASCT.
对于在传统化疗期间或之后疾病进展的转移性生殖细胞肿瘤（mGCT）患者，大剂量化疗联合自体干细胞移植（HDC-ASCT）是标准治疗方法。我们对加拿大艾伯塔省过去二十年中复发的mGCT患者进行了HDC-ASCT的回顾性研究。
从机构数据库中识别出2000年至2018年在两个省级癌症转诊中心接受HDC-ASCT的mGCT患者。收集基线临床和治疗特征，以及总生存期（OS）和无病生存期（DFS）。分析相关的预后变量。
共识别出43例患者。中位年龄为28岁（范围19 - 56岁）。大多数（95%）为非精原细胞瘤组织学类型，且原发于睾丸/腹膜后（84%）。根据国际生殖细胞共识分类（IGCCC），20例（47%）患者在一线化疗开始时具有高危疾病。65%的患者将HDC-ASCT用作二线治疗，58%的ASCT患者接受了串联移植。ASCT后的中位随访时间为22个月（范围2 - 181个月）。在最后一次随访时，42%的患者存活且无疾病，包括3/7（43%）的原发性纵隔疾病患者。两年和五年的DFS/OS率分别为44%/65%和38%/45%。所有患者的中位OS和DFS分别为30.0个月（13.3 - 46.6）和8.0个月（0.9 - 15.1）。
我们发现HDC-ASCT是mGCT的一种有效挽救治疗方法，与现有文献一致。无论原发部位如何，患者似乎都能从中受益。尽管受样本量小的限制，但我们发现二线和三线HDC-ASCT以及单次与串联ASCT之间在DFS和OS方面存在数值差异。
