Annals of Oncology Advance Access originally published online on November 27, 2007
Annals of Oncology 2008 19(2):259-264; doi:10.1093/annonc/mdm472
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urogenital tumors |
Assessing prognosis and optimizing treatment in patients with postchemotherapy viable nonseminomatous germ-cell tumors (NSGCT): results of the sCR2 international study
1 Department of Medicine, Institut Gustave Roussy, Villejuif, France
2 Department of Medical Oncology, Rikshospitalet-Radiumhospitalet Medical Center, Montebello, Oslo, Norway
3 Department of Biostatistics, Institut Gustave Roussy, Villejuif, France
4 Department of Genitourinary Medical Oncology, University of Texas MD Anderson Cancer Center, Houston, Texas, USA
5 Department of Urology, Istituto Nazionale Tumori, Milan, Italy
6 Department of Hematology/Oncology, University of Tuebingen, Germany
7 Department of Medical Oncology, Kaiser Franz-Josef Spital and LBI-ACR, Vienna, Austria
8 Department of Medical Oncology, Copenhagen National Hospital, Copenhagen, Denmark
9 Department of Medical Oncology, Centre Léon Bérard, Lyon, France
10 Department of Oncology, Santa Maria delle Croci Hospital, Ravenna, Italy
11 Department of Medical Oncology, Russian Cancer Research Center, Moscow, Russia
12 Medizinische Fakultt, Martin-Luther-Uni Halle-Wittenberg, Halle, Germany
13 Department of Pathology, Centre Hospitalier Universitaire La Miletrie, Poitiers, France
* Correspondence to: Dr K. Fizazi, Department of Medicine, Institut Gustave Roussy, 39 rue Camille Desmoulins, 94800 Villejuif, France. Tel: +33-1-42116264; Fax: +33-1-42115230; E-mail: fizazi{at}igr.fr
Background: The purpose of this study was to validate a prognostic index [surgical complete response 1 (sCR1)] in patients with postchemotherapy viable nonseminomatous germ-cell tumors (NSGCT).
Patients and methods: Data and specimens from 61 patients with normalized tumor markers and postchemotherapy viable nonteratomatous NSGCT treated in 13 institutions were collected.
Results: With a median follow-up of 5.4 years, the 5-year progression-free survival (PFS) rate was 65%; the 5-year overall survival (OS) rate was 72%. Favorable PFS was predicted by a complete resection, <10% of viable malignant cells, and a good International Germ Cell Consensus Classification group at presentation. Patients were assigned to one of three risk groups defined in sCR1: no risk factor (good risk), one risk factor (intermediate risk) and two to three risk factors (poor risk group). The 5-year PFS rate was 92%, 78%, and 42%, respectively (P = 0.002) (as compared with 90%, 76%, and 41% in the original sCR1 study). The 5-year OS rate was 90%, 86%, and 52%, respectively (P = 0.009) (as compared with 100%, 83%, and 51% in the original sCR1 study). Postoperative chemotherapy did not appear to improve OS compared with surveillance and treatment only at relapse.
Conclusion: In patients with postchemotherapy viable NSGCT, a complete resection of residual masses should be rigorously pursued. These data validate the sCR1 prognostic index. Given their excellent outcome, patients in the favorable group may not require postoperative chemotherapy.
Key words: chemotherapy, germ cell tumor, non seminoma, residual masses, surgery
Received for publication June 13, 2007. Revision received August 27, 2007. Accepted for publication September 3, 2007.
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