학술논문
Outcomes of relapsed clinical stage I versus de novo metastatic testicular cancer patients: an analysis of the IGCCCG Update database
Document Type
Original Paper
Author
Lauritsen, Jakob; Sauvé, Nicolas; Tryakin, Alexey; Jiang, Di Maria; Huddart, Robert; Heng, Daniel Y. C.; Terbuch, Angelika; Winquist, Eric; Chovanec, Michal; Hentrich, Marcus; Fankhauser, Christian D.; Shamash, Jonathan; del Muro, Xavier Garcia; Vaughn, David; Heidenreich, Axel; Sternberg, Cora N.; Sweeney, Christopher; Necchi, Andrea; Bokemeyer, Carsten; Bandak, Mikkel; Jandari, Abolghassem; Collette, Laurence; Gillessen, Silke; Beyer, Joerg; Daugaard, Gedske
Source
British Journal of Cancer. 129(11):1759-1765
Subject
Language
English
ISSN
0007-0920
1532-1827
1532-1827
Abstract
Background: Active surveillance after orchiectomy is the preferred management in clinical stage I (CSI) germ-cell tumours (GCT) associated with a 15 to 30% relapse rate.Patients and methods: In the IGCCCG Update database, we compared the outcomes of gonadal disseminated GCT relapsing from initial CSI to outcomes of patients with de novo metastatic GCT.Results: A total of 1014 seminoma (Sem) [298 (29.4%) relapsed from CSI, 716 (70.6%) de novo] and 3103 non-seminoma (NSem) [626 (20.2%) relapsed from CSI, 2477 (79.8%) de novo] were identified. Among Sem, no statistically significant differences in PFS and OS were found between patients relapsing from CSI and de novo metastatic disease [5-year progression-free survival (5y-PFS) 87.6% versus 88.5%; 5-year overall survival (5y-OS) 93.2% versus 96.1%). Among NSem, PFS and OS were higher overall in relapsing CSI patients (5y-PFS 84.6% versus 80.0%; 5y-OS 93.3% versus 88.7%), but there were no differences within the same IGCCCG prognostic groups (HR = 0.89; 95% CI: 0.70–1.12). Relapses in the intermediate or poor prognostic groups occurred in 11/298 (4%) Sem and 112/626 (18%) NSem.Conclusion: Relapsing CSI GCT patients expect similar survival compared to de novo metastatic patients of the same ICCCCG prognostic group. Intermediate and poor prognosis relapses from initial CSI expose patients to unnecessary toxicity from more intensive treatments.