Department of Medical Oncology, Basaksehir Cam and Sakura City Hospital, Istanbul, Turkey.
Department of Medical Oncology, Istanbul University Institute of Oncology, Istanbul, Turkey.
Medicine (Baltimore). 2024 Feb 23;103(8):e37213. doi: 10.1097/MD.0000000000037213.
Despite having a higher mortality risk than conventional chemotherapeutics, high-dose chemotherapy (HDCT) has the potential to be curative in relapsed/refractory germ-cell tumors. Therefore, selecting the best patient group for this treatment is critical. This study aimed to determine the factors that affect survival in our relapsed/refractory GCT cohort who received HDCT and autologous stem-cell transplantation. Between September 2010 and 2020, we included in the study 44 relapsed/refractory male patients with GCT treated with HDCT plus autologous stem-cell transplantation. The patients' demographic features, clinical characteristics, and treatment outcomes were evaluated. Statistical analyses were performed to identify risk factors associated with survival. The median age of all cohorts was 28 years. Thirty-six patients had nonseminomatous tumors, and 8 patients had seminomatous tumors. The most common primary tumor sites were the gonads (75%), followed by the mediastinum (15.9%) and the retroperitoneum (9.1%). After HDCT, 11 patients had a complete response, 12 patients had a partial response, and 17 patients had a progressive disease, respectively. About 23 patients (52.3%) experienced at least 1 treatment-related grade 3 to 4 nonhematological toxicity. About 4 patients (10%) died due to HDCT-related toxicity. The total group's median progression-free survival (PFS) was 7 months, and the median overall survival (OS) was 14.9 months. Primary tumor site (hazard ratio [HR]: 1.84; P = .028), type of HDCT regimen (HR: 0.35; P = .010), and best response to HDCT (HR: 11.0; P < .0001) were independent prognostic risk factors for PFS. The only independent prognostic risk factor associated with OS was the best response to HDCT (HR: 6.62; P = .001). The results of the study promise the best response to HDCT as a primary measure for predicting survival in relapsed/refractory GCT. In contrast, primary mediastinal GCT is not a good candidate for HDCT. Furthermore, a carboplatin-etoposide regimen in combination with cyclophosphamide and paclitaxel may improve PFS.
尽管大剂量化疗（HDCT）比传统化疗的死亡率更高，但它有可能治愈复发性/难治性生殖细胞肿瘤。因此，选择最适合这种治疗的患者群体至关重要。本研究旨在确定接受 HDCT 和自体干细胞移植的复发性/难治性 GCT 患者的生存影响因素。2010 年 9 月至 2020 年期间，我们纳入了 44 例接受 HDCT 联合自体干细胞移植治疗的复发性/难治性男性 GCT 患者。评估了患者的人口统计学特征、临床特征和治疗结果。进行了统计学分析以确定与生存相关的危险因素。所有队列的中位年龄为 28 岁。36 例患者为非精原细胞瘤肿瘤，8 例患者为精原细胞瘤肿瘤。最常见的原发肿瘤部位是性腺（75%），其次是纵隔（15.9%）和腹膜后（9.1%）。HDCT 后，11 例患者完全缓解，12 例患者部分缓解，17 例患者疾病进展。约 23 例（52.3%）患者经历了至少 1 次 3 级至 4 级非血液学毒性。约 4 例（10%）患者因 HDCT 相关毒性而死亡。总组的中位无进展生存期（PFS）为 7 个月，中位总生存期（OS）为 14.9 个月。原发肿瘤部位（风险比[HR]：1.84；P=0.028）、HDCT 方案类型（HR：0.35；P=0.010）和 HDCT 最佳反应（HR：11.0；P<0.0001）是 PFS 的独立预后危险因素。唯一与 OS 相关的独立预后危险因素是 HDCT 的最佳反应（HR：6.62；P=0.001）。研究结果表明，HDCT 的最佳反应是预测复发性/难治性 GCT 患者生存的主要指标。相比之下，原发纵隔 GCT 不是 HDCT 的合适候选者。此外，卡铂-依托泊苷方案联合环磷酰胺和紫杉醇可能会改善 PFS。
