Site of extranodal metastasis impacts survival in patients with testicular germ cell tumors

Abstract

Background Using a large, nationally representative, population‐based cancer registry, this study systematically evaluated the impact of the location and burden of extranodal testicular germ cell tumor (TGCT) metastases on survival. Methods Men with stage III TGCTs captured by the Surveillance, Epidemiology, and End Results registry from 2010 to 2015 with distant extranodal metastases were identified. Clinicopathologic information was collected, and patients were subdivided according to the specific organ site or sites of metastatic involvement (lung, liver, bone, and/or brain). Kaplan‐Meier analysis and multivariable Cox regression were used to evaluate cancer‐specific survival (CSS), and model performance was assessed with Harrell's C statistic. Results Nine hundred sixty‐nine patients with stage III TGCTs were included with predominantly nonseminomatous histology (84%). Most patients (91%) had pulmonary metastases, whereas 20%, 10%, and 10% had liver, bone, and brain metastases, respectively. Over a median follow‐up of 21 months, 19% of these men died of TGCTs. When they were grouped by the primary site of metastasis, patients with more than 1 extrapulmonary metastasis exhibited the worst CSS (hazard ratio [HR] vs isolated pulmonary involvement, 4.27; 95% confidence interval [CI], 2.60‐7.00; P < .01). Among patients with isolated extrapulmonary involvement, those with brain metastases had the poorest survival (HR, 3.24; 95% CI, 1.98‐5.28; P < .01), and they were followed by patients with liver (HR, 2.29; 95% CI, 1.56‐3.35; P < .01) and bone metastases (HR, 1.97; 95% CI, 1.11‐3.50; P = .02). Harrell's C statistic (multivariable) was 0.71. Conclusions The site of metastatic involvement affects survival outcomes for patients with TGCTs, and this may reflect both the aggressive biology and the challenging treatment of these tumors. Further incorporation of organotropism into current prognostic models for metastatic TGCTs warrants attention.

Development and validation of a nomogram to predict survival in patients with metastatic testicular germ cell tumors

“…Brian and bone metastases were relatively rare. The distribution of distant metastases is consistent with that in previous studies ( 6 , 23 ).…”

“…Poor outcomes in patients with TGCTs are driven primarily by distant metastatic involvement ( 5 ). The most common sites of metastatic TGCTs (mTGCTs) include the lymph nodes and lungs ( 6 ). Sometimes, distant metastatic sites such as the liver, bone, and brain may be involved ( 6 - 9 ).…”

“…The most common sites of metastatic TGCTs (mTGCTs) include the lymph nodes and lungs ( 6 ). Sometimes, distant metastatic sites such as the liver, bone, and brain may be involved ( 6 - 9 ).…”

Overcoming sociodemographic factors in the care of patients with testicular cancer at a safety net hospital

“…Of the 4 patients who died of their disease, 3 developed brain metastases despite chemotherapy, and this is associated with worse outcomes. 21 In addition, disease-specific mortality occurred only in patients initially presenting with either stage IIIB or IIIC disease (as opposed to progressing from stage I disease) and was not associated with hospital setting when we adjusted for IGCCCG risk group. Testicular cancer recurrence was uncommon in our cohort (5%) and fell within the reported range of 1% to 20%.…”

Peritoneal carcinosis in male germ cell tumor patients: a registry study compiled by the German Testicular Cancer Study Group (GTCSG)

“…Metastatic dissemination commonly involves the retroperitoneal lymph nodes, lymph nodes of the mediastinum, and lungs. Other metastatic sites may include liver, bone and brain which are less common and associated with adverse outcomes [5][6][7]. Until now, peritoneal carcinosis (PC) in GCT patients was described by case reports and small case series only, revealing merely little data concerning the frequency, potential causes of development and impact on the patient's outcome [8][9][10][11][12].…”