- 作者：Mikhail Fedyanin ; M.D. ; Ph.D.a ; fedianinmu@mail.ru ; Alexey Tryakin ; M.D. ; Ph.D.a ; Dheepak Kanagavel ; M.D. ; Ph.D.a ; Anatoly Bulanov ; M.D. ; Ph.D.a ; Alena Burova ; M.D.a ; Konstantin Figurin ; M.D. ; Ph.D.b ; Igor Fainshtein ; M.D. ; Ph.D.c ; Uriy Sergeev ; M.D.c ; Tatiana Zakharova ; M.D. ; Ph.D.d ; August Garin ; M.D. ; Ph.D.a ; Sergei Tjulandin ; M.D. ; Ph.D.a
- 关键词：Germ cell tumors ; Late relapse ; 1st stage ; Prognosis
- 刊名：Urologic Oncology: Seminars and Original Investigations
- 出版年：2013
- 出版时间：May, 2013
- 年：2013
- 卷：31
- 期：4
- 页码：499-504
- 全文大小：229 K
Objectives
Late relapses (>2 years) after completion of chemotherapy are rare and often platinum-resistant. There are limited data concerning late relapses in chemotherapy-na?ve patients with stage I germ cell tumors. This retrospective analysis was performed to compare the outcome between patients with stage I germ cell tumors, who had late (¡Ý2 years) and early (¡Ý3 months and <2 years) relapse after orchiectomy.Methods and materials
We analyzed data of 1,069 chemotherapy-na?ve patients with advanced germ cell tumors of testis treated in our department from 1986 to 2008. All patients had cisplatin- and etoposide-based chemotherapy. We identified 169 (15.8 % ) patients with prior stage I disease, who had not received adjuvant treatment: 140 and 29 patients had early and late relapse, respectively. Among patients with late relapse, pure seminoma was revealed in 14 patients, and nonseminoma in 15 patients. Median follow-up time for 169 patients was 35 (range, 2-218) months.
Results
Patients with late relapse were older, 35 years (23-57) and had more frequent pure seminoma in primary tumor, 14/29 (48.3 % ), than patients with early relapse, 30 years (16-63) (P = 0.0008) and 46/140 (32,8 % , P = 0.08), respectively. At the time of disease progression, both groups were very similar according to well-known prognostic factors including IGCCCG classification. The only difference was larger size of retroperitoneal lymph nodes in late (9 cm) than in early relapse (4 cm, P < 0.0001). The outcome in patients with late relapse was significantly worse than in patients with early relapse: complete response rate after induction chemotherapy was 20.7 % (6/29) vs. 42.1 % (59/140) (P = 0.01), 3-year progression-free survival 66 % vs. 84 % (P = 0.02, HR = 2.4, 95 % CI 1.2-8.8) and 3-year overall survival, 72 % vs. 88 % (P = 0.04, HR = 2.4, 95 % CI 1.05-10.25), respectively. In patients with pure seminoma, this difference in overall survival was even more significant: 65 % vs. 91 % (P = 0.04, HR = 3.8, 95 % CI 1.06-32.4).
Conclusions
Late relapses following stage I germ cell tumors were associated with seminoma, older age, and worse outcome after induction chemotherapy.