Prognostic factors in patients progressing after cisplatin-based chemotherapy for malignant non-seminomatous germ cell tumours.

2.50
Hdl Handle:
http://hdl.handle.net/10541/88026
Title:
Prognostic factors in patients progressing after cisplatin-based chemotherapy for malignant non-seminomatous germ cell tumours.
Authors:
Fosså, Sophie D; Stenning, Sally P; Gerl, A; Horwich, Alan; Clark, Peter I; Wilkinson, Peter M; Jones, W G; Williams, M V; Oliver, R T; Newlands, Edward S; Mead, Graham M; Cullen, Michael H; Kaye, Stan B; Rustin, G J; Cook, P A
Abstract:
The aim of this study was to define prognostic parameters for survival in patients with malignant germ cell tumours progressing after platinum-based induction chemotherapy with or without surgery. A total of 164 progressing patients (testicular: 83%, extragonadal: 17%) were identified out of 795 patients treated with platinum-based induction chemotherapy for metastatic germ cell malignancy with or without surgery. 'Progressive disease' included patients who had progressed after a previous partial or complete remission as well as patients who failed primary therapy. Salvage chemotherapy consisted of 'conventional' platinum-based chemotherapy. Prognostic factors for survival were assessed by uni- and multivariate analyses. The resulting prognostic model was validated in an independent data set of 66 similar patients. For all 164 patients the median time from start of induction chemotherapy to progression was 10 months (range: 0-99). Thirty-eight (23%) patients relapsed after 2 years. The 5-year survival rate for all progressing patients was 30% (95% confidence interval 23-38%). In the univariate analysis the following factors most importantly predicted a poor prognosis: progression-free interval < 2 years: initial poor prognosis category (MRC criteria), < CR to induction chemotherapy, initial treatment early in the 1980s and treatment given at a 'small' centre. Three prognostic factors remained in the multivariate analysis: progression-free interval, response to induction treatment and the level of serum human chronic gonadotrophin (hCG) and alpha fetoprotein (AFP) at relapse. One hundred and twenty-four patients could be classified on the basis of these characteristics, Those patients with progression-free interval < 2 years, < CR to induction chemotherapy and high markers at relapse (AFP >100 kU l(-1) or hCG >100 IU l(-1)) formed a poor prognosis group of 30 patients, none of whom survived after 3 years. Patients with at most two of these three risk factors formed a good prognosis group of 94 patients (76%) with a 47% (37-56%) 5-year survival. Thirty-eight patients from the good prognosis group with a progression-free interval of >2 years had a 2-year survival of 74% (60-88%) and 5-year survival of 61%. These prognostic groups were validated in the independent data set, in which 5-year survival rates in the good and poor risk groups were 51% and 0% respectively. One-third of patients progressing during or after platinum-based induction chemotherapy for metastatic germ cell malignancy may be cured by repeated 'conventional' platinum-based chemotherapy. Good prognosis parameters are: progression-free interval of > 2 years, CR to induction treatment and normal or low serum markers at relapse (hCG < 100 IU l(-1) and AFP < 100 kU l(-1)). The results of high-dose salvage chemotherapy should be interpreted on the background of these prognostic factors.
Affiliation:
Department of Medical Oncology and Radiotherapy, The Norwegian Radium Hospital, Montebello, Oslo.
Citation:
Prognostic factors in patients progressing after cisplatin-based chemotherapy for malignant non-seminomatous germ cell tumours. 1999, 80 (9):1392-9 Br. J. Cancer
Journal:
British Journal of Cancer
Issue Date:
Jul-1999
URI:
http://hdl.handle.net/10541/88026
DOI:
10.1038/sj.bjc.6690534
PubMed ID:
10424741
Type:
Article
Language:
en
ISSN:
0007-0920
Appears in Collections:
All Christie Publications

Full metadata record

DC FieldValue Language
dc.contributor.authorFosså, Sophie Den
dc.contributor.authorStenning, Sally Pen
dc.contributor.authorGerl, Aen
dc.contributor.authorHorwich, Alanen
dc.contributor.authorClark, Peter Ien
dc.contributor.authorWilkinson, Peter Men
dc.contributor.authorJones, W Gen
dc.contributor.authorWilliams, M Ven
dc.contributor.authorOliver, R Ten
dc.contributor.authorNewlands, Edward Sen
dc.contributor.authorMead, Graham Men
dc.contributor.authorCullen, Michael Hen
dc.contributor.authorKaye, Stan Ben
dc.contributor.authorRustin, G Jen
dc.contributor.authorCook, P Aen
dc.date.accessioned2009-12-15T16:02:18Z-
dc.date.available2009-12-15T16:02:18Z-
dc.date.issued1999-07-
dc.identifier.citationPrognostic factors in patients progressing after cisplatin-based chemotherapy for malignant non-seminomatous germ cell tumours. 1999, 80 (9):1392-9 Br. J. Canceren
dc.identifier.issn0007-0920-
dc.identifier.pmid10424741-
dc.identifier.doi10.1038/sj.bjc.6690534-
dc.identifier.urihttp://hdl.handle.net/10541/88026-
dc.description.abstractThe aim of this study was to define prognostic parameters for survival in patients with malignant germ cell tumours progressing after platinum-based induction chemotherapy with or without surgery. A total of 164 progressing patients (testicular: 83%, extragonadal: 17%) were identified out of 795 patients treated with platinum-based induction chemotherapy for metastatic germ cell malignancy with or without surgery. 'Progressive disease' included patients who had progressed after a previous partial or complete remission as well as patients who failed primary therapy. Salvage chemotherapy consisted of 'conventional' platinum-based chemotherapy. Prognostic factors for survival were assessed by uni- and multivariate analyses. The resulting prognostic model was validated in an independent data set of 66 similar patients. For all 164 patients the median time from start of induction chemotherapy to progression was 10 months (range: 0-99). Thirty-eight (23%) patients relapsed after 2 years. The 5-year survival rate for all progressing patients was 30% (95% confidence interval 23-38%). In the univariate analysis the following factors most importantly predicted a poor prognosis: progression-free interval < 2 years: initial poor prognosis category (MRC criteria), < CR to induction chemotherapy, initial treatment early in the 1980s and treatment given at a 'small' centre. Three prognostic factors remained in the multivariate analysis: progression-free interval, response to induction treatment and the level of serum human chronic gonadotrophin (hCG) and alpha fetoprotein (AFP) at relapse. One hundred and twenty-four patients could be classified on the basis of these characteristics, Those patients with progression-free interval < 2 years, < CR to induction chemotherapy and high markers at relapse (AFP >100 kU l(-1) or hCG >100 IU l(-1)) formed a poor prognosis group of 30 patients, none of whom survived after 3 years. Patients with at most two of these three risk factors formed a good prognosis group of 94 patients (76%) with a 47% (37-56%) 5-year survival. Thirty-eight patients from the good prognosis group with a progression-free interval of >2 years had a 2-year survival of 74% (60-88%) and 5-year survival of 61%. These prognostic groups were validated in the independent data set, in which 5-year survival rates in the good and poor risk groups were 51% and 0% respectively. One-third of patients progressing during or after platinum-based induction chemotherapy for metastatic germ cell malignancy may be cured by repeated 'conventional' platinum-based chemotherapy. Good prognosis parameters are: progression-free interval of > 2 years, CR to induction treatment and normal or low serum markers at relapse (hCG < 100 IU l(-1) and AFP < 100 kU l(-1)). The results of high-dose salvage chemotherapy should be interpreted on the background of these prognostic factors.en
dc.language.isoenen
dc.subjectTesticular Canceren
dc.subject.meshAdolescent-
dc.subject.meshAdult-
dc.subject.meshAged-
dc.subject.meshAged, 80 and over-
dc.subject.meshAntineoplastic Agents-
dc.subject.meshCisplatin-
dc.subject.meshGerminoma-
dc.subject.meshHumans-
dc.subject.meshMale-
dc.subject.meshMiddle Aged-
dc.subject.meshPrognosis-
dc.subject.meshSalvage Therapy-
dc.subject.meshTesticular Neoplasms-
dc.titlePrognostic factors in patients progressing after cisplatin-based chemotherapy for malignant non-seminomatous germ cell tumours.en
dc.typeArticleen
dc.contributor.departmentDepartment of Medical Oncology and Radiotherapy, The Norwegian Radium Hospital, Montebello, Oslo.en
dc.identifier.journalBritish Journal of Canceren
All Items in Christie are protected by copyright, with all rights reserved, unless otherwise indicated.