Prognostic factors for relapse after complete response in patients with metastatic germ cell tumors

Geller, Nancy L.; Bosl, George J.; Chan, Eva

doi:10.1002/1097-0142(19890201)63:3<440::aid-cncr2820630308>3.0.co;2-7

Cited by 48 publications

(12 citation statements)

References 9 publications

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“…Incompletely resected patients had a poor prognosis (5y-RF%:50%), as was found in other studies (Tait et al, 1984;Harding et al, 1989;Jansen et al, 1991). (Harding et al, 1989), but in contrast with the observations in several other studies (Tait et al, 1984;Geller et al, 1989;Jansen et al, 1991;Mead et al, 1992). The observation in our study may be explained by lack of power to detect an existing difference due to the relatively low number of relapses.…”

Section: Discussionmentioning

confidence: 48%

Prognosis after resection of residual masses following chemotherapy for metastatic nonseminomatous testicular cancer: a multivariate analysis

Steyerberg

Keizer²,

Zwartendijk³

et al. 1993

Br J Cancer

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Cisplatin combination chemotherapy yields a 60-80% cure rate in metastatic nonseminomatous germ cell tumours (NSGCT) of the testis (Peckham, 1988;Stoter et al., 1989;Einhorn, 1990 (Peckham 1988;Einhorn, 1990). After completion of induction chemotherapy, the size of metastases was determined on CT scan. If residual masses were detected (> 1 cm). resection was planned, provided that tumour markers were normal. If tumour markers remained elevated, additional chemotherapy was usually given until normalisation of tumour markers, and subsequent resection was performed of residual masses (n = 5). In 99 patients residual masses were resected. Excluded were the following patients to prevent prognostic inhomogeneity: patients not treated according to standard protocol (e.g. treated with radiotherapy before induction chemotherapy) (n = 7); patients with extragonadal tumours (n = 3); patients who were operated while tumour markers were above normal (n = 3). After this selection 86 patients were studied. Patient dataAll patient data were updated until October 1991. The histological diagnosis of the original testicular cancer was made in the participating hospitals and was reviewed for patients in EORTC trials. In the analysis, the British classification (Pugh, 1976), was used. The disease was staged according to the Royal Marsden Hospital classification (Peckham, 1988). Further, the maximum transverse diameter of abdominal masses, the maximum transverse diameter of pulmonary tumour nodules, and the number of lung metastases were determined on computed tomographic (CT) scan before and after chemotherapy. The highest serum levels of AFP (ng ml-I) and HCG (IU 1') prior to chemotherapy were recorded. The type and number of chemotherapy regimens were registered, before and after resection, as well as the completeness of resection as noted by the surgeon, and the type of histology in the resected material. The data were divided in three groups of potential prognostic facors:factors known at the start of cytostatic treatment ('prechemotherapy factors'), factors known after chemotherapy but before resection ('postchemotherapy fac-

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Section: Discussionmentioning

confidence: 48%

Prognosis after resection of residual masses following chemotherapy for metastatic nonseminomatous testicular cancer: a multivariate analysis

Steyerberg

Keizer²,

Zwartendijk³

et al. 1993

Br J Cancer

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“…16, [21][22][23][24] In the adult population, tumor marker decline has been shown to be an independent predictor of prognosis after the start of therapy, indicating patients for whom a more aggressive treatment strategy should be considered. 16, [21][22][23][24] In the adult population, tumor marker decline has been shown to be an independent predictor of prognosis after the start of therapy, indicating patients for whom a more aggressive treatment strategy should be considered.…”

Section: Discussionmentioning

confidence: 99%

α‐Fetoprotein as a predictor of outcome for children with germ cell tumors: A report from the Malignant Germ Cell International Consortium

O’Neill

Xia

Krailo

et al. 2019

Cancer

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BACKGROUND:There are several studies describing the correlation between unsatisfactory tumor marker decline and a poor prognosis for adult patients treated for germ cell tumors. In pediatric patients, the data are limited. Therefore, this study retrospectively analyzed data from Children's Oncology Group (COG) protocol AGCT0132 to determine whether a relationship exists between α-fetoprotein (AFP) decline and outcome. METHODS: One hundred thirty-one patients with germ cell tumors who were enrolled in COG protocol AGCT0132 were eligible for this analysis of AFP decline. The serum AFP half-life was calculated from levels collected postoperatively as a baseline and after the start of chemotherapy. AFP decline was defined as automatically satisfactory (AFP normalized within the first 2 AFP measures after the start of chemotherapy), calculated satisfactory (AFP half-life ≤7 days after the start of chemotherapy), and unsatisfactory. RESULTS: The 3-year cumulative incidence of relapse was 11% (95% confidence interval [CI], 6.0%-18%) for patients with a satisfactory decline and 38% (95% CI, 13%-64%) for patients with an unsatisfactory decline (P = .006). In stratified analyses, this effect was limited to patients who were 11 years of age or older and had standard risk 2 (SR2) disease (P = .004 and P = .007, respectively). Three-year overall survival (OS) for patients with a satisfactory decline versus an unsatisfactory decline was not statistically significant. CONCLUSIONS: This study is the first to show an association between AFP decline and the cumulative incidence of relapse in pediatric patients treated for germ cell tumors. Recognition of patients at high risk for relapse may allow for early intensification of therapy, which could affect future clinical trial design. Cancer 2019;125:3649-3656. : Conceptualization, data curation, formal analysis, investigation, methodology, project administration, resources, funding acquisition, drafting of the article, supervision, validation, and final approval of the version to be published. Caihong Xia: Conceptualization, data curation, formal analysis, investigation, methodology, project administration, resources, drafting of the article, supervision, validation, and final approval of the version to be published. Mark D. Krailo: Conceptualization, data curation, formal analysis, investigation, methodology, project administration, resources, drafting of the article, supervision, validation, and final approval of the version to be published. Furqan Shaikh: Conceptualization, data curation, formal analysis, investigation, methodology, project administration, resources, and final approval of the version to be published. Farzana D. Pashankar: Conceptualization, data curation, formal analysis, investigation, methodology, project administration, resources, and final approval of the version to be published. Deborah F. Billmire: Conceptualization, data curation, formal analysis, investigation, methodology, project administration, resources, and final approval of the version to be publis...

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“…Geller et al at Memorial Sloan Kettering Cancer Center [5] reported on prognostic factors for relapse in 216 patients who had complete responses to cisplatin-based chemotherapy. Viable NSGCT in postchemotherapy resection specimens was associated with the highest risk of relapse.…”

Section: Discussionmentioning

confidence: 99%

“…The initial report by Einhorn et al [10] acknowledged the poor prognosis and high risk of relapse in patients with viable NSGCT in resections performed after primary chemotherapy and suggested that these patients would benefit from additional chemotherapy. Stoter et al [14] and Geller et al [5] have advocated this approach on the basis of their experience with 17 and 18 patients, respectively. Other investigators have similarly advocated postoperative chemotherapy [15][16][17][18].…”

Section: Discussionmentioning

confidence: 99%

“…Conversely, the finding of viable-appearing nonseminomatous germ-cell tumor (NSGCT) in the postchemotherapy resection specimen has been associated with a high risk of relapse if no postoperative chemotherapy is given [4,5]. For this reason, it has become standard practice to give an additional two cycles of cisplatin-based induction chemotherapy when viable NSGCT is identified.…”

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confidence: 99%

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Persistent cancer in postchemotherapy retroperitoneal lymph-node dissection: outcome analysis

et al. 1994

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Surgery following chemotherapy for treatment of metastatic testis cancer is reserved for partial remissions with localized tumors considered resectable. After primary chemotherapy, about 90% will have teratoma or necrosis and only 10% will have cancer. The concept of two cycles of post operative chemotherapy in this small group with cancer is supported by a 70% long term cure rate. A more difficult group of patients are those who have had not only primary but also salvage chemotherapy for refractory tumor. About 55% of these patients undergoing post (salvage) chemotherapy RPLND surgery have persistent cancer in the resected specimen. There is no data to support the routine use of repeat salvage chemotherapy post operatively. Of 91 patients presenting for surgery post salvage chemotherapy, 53 were considered completely resected and 36 incompletely resected. Of the 53 realistic candidates for cure with complete resections, 25 were given post operative repeat salvage chemotherapy and 28 received none. 9 (36%) receiving more chemotherapy remained NED and 12 (43%) receiving none remained NED. 12 in each group died of disease. Therefore, there is no data to support routine repeat salvage chemotherapy in patients considered completely resected who had already received salvage chemotherapy pre-operatively. Rather the outcome in this cohort depends more on the completeness of its resectability. Testicular cancer has become the model for a curable neoplasm [1]. With cisplatin-based chemotherapy and the integration of postchemotherapy resection of residual neoplastic deposits, one can expect an overall cure rate of approximately 80% in patients presenting with disseminated disease. Of the patients requiring resections of residual disease after primary chemotherapy, historically, approximately 90% will have either necrosis or teratoma in their resected specimens. This number drops to 50% in patients resected after salvage chemotherapy [2]. In those cases in which necrosis or teratoma is the histologic diagnosis, it is clear that no further chemotherapy is immediately indicated since these patients have historically done quite well,with only a few patients requiring any further chemotherapy for relapsed disease. However, further surgery is often required for patients with bulky (> 5 cm) teratoma, who are at high risk for recurrent teratoma [3].Conversely, the finding of viable-appearing nonseminomatous germ-cell tumor (NSGCT) in the postchemotherapy resection specimen has been associated with a high risk of relapse if no postoperative chemotherapy is given [4,5]. For this reason, it has become standard practice to give an additional two cycles of cisplatin-based induction chemotherapy when viable NSGCT is identified. This chemotherapy is given on the presumption that even with an apparently complete surgical resection there is residual microscopic NSGCT that would potentially be eradicated by an additional two cylces of induction chemotherapy.This concept of giving an additional two cycles of induction chemotherapy postoperat...

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Prognostic factors for relapse after complete response in patients with metastatic germ cell tumors

Cited by 48 publications

References 9 publications

Prognosis after resection of residual masses following chemotherapy for metastatic nonseminomatous testicular cancer: a multivariate analysis

Prognosis after resection of residual masses following chemotherapy for metastatic nonseminomatous testicular cancer: a multivariate analysis

α‐Fetoprotein as a predictor of outcome for children with germ cell tumors: A report from the Malignant Germ Cell International Consortium

Persistent cancer in postchemotherapy retroperitoneal lymph-node dissection: outcome analysis

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