Comparison of criteria for assigning germ cell tumor patients to "good risk" and "poor risk" studies.

Bajorin, Dean F.; Katz, Angela; Chan, Eva; Geller, Nancy L.; Vogelzang, N.; Bosl, George J.

doi:10.1200/jco.1988.6.5.786

Cited by 118 publications

(35 citation statements)

References 6 publications

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“…These data suggest osseus metastases may not confer such an adverse prognosis as is commonly believed (Bosl et al, 1986;Einhorn et al, 1985;Logothetis et al, 1986;Williams et al, 1987;Bajorin et al, 1988).…”

Section: Resultsmentioning

confidence: 62%

Bone disease in testicular and extragonadal germ cell tumours

Hitchins

Philip²,

Wignall³

et al. 1988

Br J Cancer

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Summary Of 297 patients with metastatic testicular and extragonadal germ cell tumours (GCT), bone involvement was detected clinically in 3% (7/251) of those at first presentation and in 9% (4/46) of relapsed cases. This difference was not statistically significant (95% confidence limits -2%; +14%). Concurrent systemic metastases, commonly involving lung (7/11 cases) and para-aortic lymph nodes (6/11), were present in all patients with bone disease. All affected patients had localized bone pain and lumbar spine was the most frequent site involved (9/11). Spinal cord compression occurred in two patients while a third developed progressive vertebral collapse after chemotherapy and required extensive surgical reconstruction. At median follow-up of 4 years, survival among patients presenting with bone disease (6/7) was similar to overall survival in the whole group (84%) and appeared better than in those with liver (18/26, 69%) or central nervous system (6/9) metastases at presentation.Back pain in metastatic germ cell tumours is often due to retroperitoneal lymphadenopathy but lumbar spine osseus metastases must be recognized early if severe potential complications, such as spinal cord compression, are to be avoided. In this series, bone metastases were not seen in the absence of widespread systemic disease suggesting all solitary bony lesions in GCT patients should be biopsied.Bone is an uncommon site for metastases from testicular and extragonadal germ cell tumours (GCT) (Pugh, 1982). The large study of Dixon & Moore (1953) described metastases seen in 1,000 testicular GCT affecting United States servicemen to January 1948. Autopsy-proven bony metastases were seen in 21% of GCT containing mainly embryonal carcinoma and 36% of those with predominant teratoma but not in other histologic types. Bones of the trunk were involved most commonly. Mostofi (1973) reported 6,000 testicular tumours on the American Registry of Pathology over 25 years and noted a similar distribution of osseus metastases. These pathologic series largely predated the considerable recent advances in treatment of GCT and in methods for demonstrating bone metastases radiologically during life. With optimal radiotherapeutic techniques in seminoma, very high overall cure rates have been possible for over 20 years (Ball et al., 1982;Duncan & Munro, 1987;Hay et al., 1984). Isotope bone scans, computerized tomography (CT) and, most recently, magnetic resonance imaging (MRI) have provided much more sensitive means for diagnosing bone involvement than plain radiographs.Johnson et al. (1976) reported an autopsy series of testicular GCT where 47% of bony metastases were seen among seminoma patients, significantly more than in all other histologic subtypes. Bredael et al. (1982) showed similar results in another postmortem series. This apparent change in metastatic pattern from the older series may reflect radiotherapy-induced modification of seminoma natural history with retroperitoneal disease controlled but late recurrence occurring in other sites, incl...

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Section: Resultsmentioning

confidence: 62%

Bone disease in testicular and extragonadal germ cell tumours

Hitchins

Philip²,

Wignall³

et al. 1988

Br J Cancer

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“…Other factors associated with GCC-specific mortality were decreased lung function and renal function before BEP treatment as well as recognized risk factors, such as poor prognostic group and primary extragonadal tumor. 10,11 The current results advocate against the assumptions that the increased mortality in older patients with testicular GCC is mainly because of reduced treatment intensity combined with increased treatmentrelated toxicity or a less favorable stage distribution. Different biologic behavior of the tumors or increased comorbidity also may be part of the explanation.…”

Section: Discussionmentioning

confidence: 76%

Survival and toxicity in patients with disseminated germ cell cancer aged 40 years and older

Thomsen

Bandak

Thomsen

et al. 2013

Cancer

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BACKGROUND: Germ-cell cancer (GCC) patients aged 40 years have a two-fold higher GCC-specific mortality. It has been hypothesized that reduced treatment intensity combined with increased treatment related toxicity could be the explanation. The objective was to analyze chemotherapy intensity, treatment related toxicity and survival in patients aged 40 years treated with standard chemotherapy for GCC compared with a younger control group that received similar treatment during the same period. METHODS: From 1984 to 2011, 135 patients aged 40 years with disseminated GCC treated with bleomycin, etoposide and cisplatin (BEP). A control-group of 135 patients aged 18-35 years was randomly selected matched on year of BEP treatment. Cumulated doses of BEP as well as bone marrow toxicity, renal-and lung functions were recorded before, during and after termination of treatment. All patients were followed until death or October 1, 2011. RESULTS: The cumulated doses of BEP were comparable between the two groups, however, more patients aged 40 years were reduced in bleomycin doses based on a decrease in carbon monoxide diffusion capacity corrected for haemoglobin (P 5 0.03). No differences between the two groups were found regarding bone marrow toxicity or mean percentage changes in lung-or renal function. Patients aged 40 year had increased cancer specific mortality, HR 5 4.8 (P 5 0.005). In particular patients with disease progression after first line chemotherapy had increased mortality (P 5 0.015). Moreover, the 5-year overall survival for patients aged 40 years was 82.5% compared to the expected 5-year survival of the background population of 96.3% (P <0.001). CONCLUSIONS: Treatment related toxicity could not explain the increased cancer specific mortality in patients aged 40 years compared to a younger control-group, and while there were no differences in the administrated doses of cisplatin/ etoposide, a decreased number of bleomycin doses were administered in the older patients. Apart from this, the inferior prognosis could be related to tumour biology, increased co-morbidity, or more severe toxicity in relation to second line treatment. Cancer 2014;120:43-51.

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“…Several classifications have been proposed in the past to distinguish patients according to prognosis, by identifying and combining the main prognostic factors for progression-free survival (PFS) and overall survival (Bajorin et al, 1988(Bajorin et al, , 1991Mead et al, 1992). The coexistence of classifications differing in type, complexity and ability to separate good from poor prognosis complicated international collaboration in randomised trials and made comparison of nonrandomised studies impossible.…”

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confidence: 99%

Survival of patients with nonseminomatous germ cell cancer: a review of the IGCC classification by Cox regression and recursive partitioning

et al. 2004

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The International Germ Cell Consensus (IGCC) classification identifies good, intermediate and poor prognosis groups among patients with metastatic nonseminomatous germ cell tumours (NSGCT). It uses the risk factors primary site, presence of nonpulmonary visceral metastases and tumour markers alpha-fetoprotein (AFP), human chorionic gonadotrophin (HCG) and lactic dehydrogenase (LDH). The IGCC classification is easy to use and remember, but lacks flexibility. We aimed to examine the extent of any loss in discrimination within the IGCC classification in comparison with alternative modelling by formal weighing of the risk factors. We analysed survival of 3048 NSGCT patients with Cox regression and recursive partitioning for alternative classifications. Good, intermediate and poor prognosis groups were based on predicted 5-year survival. Classifications were further refined by subgrouping within the poor prognosis group. Performance was measured primarily by a bootstrap corrected c-statistic to indicate discriminative ability for future patients. The weights of the risk factors in the alternative classifications differed slightly from the implicit weights in the IGCC classification. Discriminative ability, however, did not increase clearly (IGCC classification, c ¼ 0.732; Cox classification, c ¼ 0.730; Recursive partitioning classification, c ¼ 0.709). Three subgroups could be identified within the poor prognosis groups, resulting in classifications with five prognostic groups and slightly better discriminative ability (c ¼ 0.740). In conclusion, the IGCC classification in three prognostic groups is largely supported by Cox regression and recursive partitioning. Cox regression was the most promising tool to define a more refined classification.

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Comparison of criteria for assigning germ cell tumor patients to "good risk" and "poor risk" studies.

Cited by 118 publications

References 6 publications

Bone disease in testicular and extragonadal germ cell tumours

Bone disease in testicular and extragonadal germ cell tumours

Survival and toxicity in patients with disseminated germ cell cancer aged 40 years and older

Survival of patients with nonseminomatous germ cell cancer: a review of the IGCC classification by Cox regression and recursive partitioning

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