Impact of teratoma on the cumulative incidence of disease-related death in patients with advanced germ cell tumors Journal Article


Authors: Funt, S. A.; Patil, S.; Feldman, D. R.; Motzer, R. J.; Bajorin, D. F.; Sheinfeld, J.; Tickoo, S. K.; Reuter, V. E.; Bosl, G. J.
Article Title: Impact of teratoma on the cumulative incidence of disease-related death in patients with advanced germ cell tumors
Abstract: PURPOSE In men with metastatic germ cell tumors (GCTs), risk-directed treatment is determined, in part, by a distinction between seminoma and nonseminomatous GCT (NSGCT). The importance of NSGCT cell type is uncertain. We evaluated the long-term impact of teratoma on survival in patients with NSGCT. METHODS Prechemotherapy, primary tumors from patients who received platinum-based chemotherapy were studied, and the histology was confirmed by a genitourinary pathologist. The cumulative incidence of disease-related death (CIDD) was the primary end point, and a competing-risk analysis was performed. RESULTS Tumors were available from 232 patients, including 193 with NSGCT. An element of teratoma was present in 82 NSGCT primary tumors (42%). With a median follow-up of 17 years (range, 0.3 to 35 years), 58 patients with NSGCT died, 47 as a result of GCT and 11 as a result of other causes. Most GCT deaths occurred within the first 5 years and were associated with pretreatment risk status (P, .001). Death as a result of other causes rose steadily after 15 years and was not associated with risk status (P = .66). A higher CIDD was observed in patients who had NSGCT with teratoma than those with NSGCT without teratoma and seminoma (5-year CIDD rate, 27.4%, 17.4%, and 10.3%, respectively; P = .03). A higher CIDD was observed in patients who had NSGCT with mature teratoma compared with those with either NSGCT with immature teratoma or NSGCT without teratoma (5-year CIDD rate, 38.1%, 19.9%, and 17.4%, respectively; P = .01). CONCLUSION The presence of teratoma, particularly mature teratoma, in an NSGCT primary tumor is associated with a higher CIDD, consistent with the hypothesis that differentiation is associated with adverse outcomes. Death as a result of non-GCT causes is not associated with risk status and must be separated from GCT death when evaluating long-term survival. © 2019 by American Society of Clinical Oncology
Journal Title: Journal of Clinical Oncology
Volume: 37
Issue: 26
ISSN: 0732-183X
Publisher: American Society of Clinical Oncology  
Date Published: 2019-09-10
Start Page: 2329
End Page: 2337
Language: English
DOI: 10.1200/jco.18.01608
PUBMED: 31233353
PROVIDER: scopus
DOI/URL:
Notes: Article -- Export Date: 1 October 2019 -- Source: Scopus
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MSK Authors
  1. Sujata Patil
    413 Patil
  2. Stacey Funt
    7 Funt
  3. Dean Bajorin
    449 Bajorin
  4. Robert Motzer
    824 Motzer
  5. Satish K Tickoo
    379 Tickoo
  6. Darren Richard Feldman
    189 Feldman
  7. Joel Sheinfeld
    212 Sheinfeld
  8. Victor Reuter
    999 Reuter
  9. George Bosl
    311 Bosl
  10. Samuel Aaron Funt
    26 Funt