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Identification of a subgroup with worse prognosis among patients with poor‐risk testicular germ cell tumor
Author(s) -
Kojima Takahiro,
Kawai Koji,
Tsuchiya Kunihiko,
Abe Takashige,
Shinohara Nobuo,
Tanaka Toshiaki,
Masumori Naoya,
Yamada Shigeyuki,
Arai Yoichi,
Narita Shintaro,
Tsuchiya Norihiko,
Habuchi Tomonori,
Nishiyama Hiroyuki
Publication year - 2015
Publication title -
international journal of urology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.172
H-Index - 67
eISSN - 1442-2042
pISSN - 0919-8172
DOI - 10.1111/iju.12844
Subject(s) - medicine , germ cell tumors , ifosfamide , bleomycin , etoposide , chemotherapy , testicular cancer , testicular germ cell tumor , oncology , cisplatin , human chorionic gonadotropin , germ cell , gastroenterology , hormone , biochemistry , chemistry , gene
Objectives To clarify the significance of the International Germ Cell Cancer Collaborative Group classification in the 2000s, especially in intermediate‐ and poor‐prognosis testicular germ cell tumor in Japan. Methods We retrospectively analyzed 117 patients with intermediate‐ and poor‐prognosis testicular non‐seminomatous germ cell tumor treated at five university hospitals in Japan between 2000 and 2010. Data collected included age, levels of tumor markers, spread to non‐pulmonary visceral metastases, treatment details and survival. Results The median follow‐up period of all patients was 57 months. A total of 50 patients (43%) were classified as having intermediate prognosis, and 67 patients (57%) as poor prognosis according to the International Germ Cell Cancer Collaborative Group classification. As first‐line chemotherapy, 92 patients (79%) received bleomycin, etoposide and cisplatin. Of all patients, 74 patients (63%) received second‐line chemotherapy. The most commonly used second‐line chemotherapy regimens were a combination of taxanes, ifosfamide and platinum in 49 cases (66%). Overall, 33 patients (28%) received third‐line chemotherapy. A total of 88 patients (75%) underwent post‐chemotherapy surgery. The 5‐year overall survival for intermediate ( n = 50) and poor prognosis ( n = 67) was 89% and 83% ( P = 0.21), respectively. In poor prognosis patients, patients with two or more risk factors (any of high lactic dehydrogenase, alpha‐fetoprotein and human chorionic gonadotropin levels, and presence of non‐pulmonary visceral metastases) had significantly worse survival than those with only one risk factor (71% and 91%, respectively, P = 0.01). Conclusions The 5‐year overall survivals of poor‐prognosis testicular non‐seminomatous germ cell tumor patients reached 83%. Further stratification of poor‐prognosis patients based on a number of risk factors has the potential to further identify those with poorer prognosis.