Gerl A, Clemm C, Schmeller N, Hartenstein R, Lamerz R, Wilmanns W
Department of Internal Medicine III, Klinikum Grosshadern, University of Munich, Germany.
Br J Cancer. 1996 Oct;74(8):1280-5. doi: 10.1038/bjc.1996.530.
Long-term outcome was reviewed in 266 consecutive patients with metastatic non-seminomatous germ cell tumours treated at a single institution. The overall 3 year survival was 77%, and 3 year progression-free survival was 71%. Multivariate analysis identified the following clinical features as independent prognostic factors: the presence of liver, bone or brain metastasis, serum human chorionic gonadotropin > or = 10000 U l-1 and/or alpha-fetoprotein > or = 1000 ng ml-1, a mediastinal mass > 5 cm and the presence of 20 or more lung metastases. Age was not of prognostic significance. Patients without any of the above poor-risk factors had a 3 year survival of 91% regardless of etoposide- or vinblastine-containing chemotherapy compared with 61% for the remaining patients. However, etoposide-containing protocols led to significantly improved survival in patients with at least one poor risk factor. After 612 patient-years of observation no case of secondary leukaemia was observed among 119 surviving patients who had received etoposide as part of their treatment. With a median follow-up of 93 months, five patients developed a second germ cell tumour, two patients nongerm cell malignancies. Fourteen patients relapsed after a disease-free interval of more than 2 years, and nine patients died more than 5 years after commencement of treatment underscoring the need to report long-term results. There is some evidence that cumulative experience translates into improved survival and cure rates for patients with poor-risk metastatic disease.
对在单一机构接受治疗的266例连续性转移性非精原细胞瘤患者的长期预后进行了回顾。3年总生存率为77%，3年无进展生存率为71%。多变量分析确定了以下临床特征为独立的预后因素：存在肝、骨或脑转移，血清人绒毛膜促性腺激素>或 = 10000 U l-1和/或甲胎蛋白>或 = 1000 ng ml-1，纵隔肿块>5 cm以及存在20个或更多的肺转移。年龄无预后意义。无上述任何不良风险因素的患者，无论接受含依托泊苷或长春碱的化疗，其3年生存率均为91%，而其余患者为61%。然而，含依托泊苷的方案使至少有一个不良风险因素的患者生存率显著提高。在612患者年的观察期内，119例接受依托泊苷治疗的存活患者中未观察到继发性白血病病例。中位随访93个月，5例患者发生了第二个生殖细胞瘤，2例患者发生了非生殖细胞恶性肿瘤。14例患者在无病间隔超过2年后复发，9例患者在治疗开始5年多后死亡，这突出了报告长期结果的必要性。有证据表明，积累的经验可提高不良风险转移性疾病患者的生存率和治愈率。
