Clinical outcome and predictors of survival in late relapse of germ cell tumor Journal Article

Authors: Sharp, D. S.; Carver, B. S.; Eggener, S. E.; Kondagunta, G. V.; Motzer, R. J.; Bosl, G. J.; Sheinfeld, J.
Article Title: Clinical outcome and predictors of survival in late relapse of germ cell tumor
Abstract: Purpose: Late relapse (LR) of germ cell tumor (GCT) is a well recognized entity associated with poor survival. We report on our experience with LR and determine predictors of survival. Patients and Methods: From 1990 to 2004, 75 patients were managed for LR of GCT at our institution. Clinical and pathologic parameters were reviewed. Estimates of cancer-specific survival were generated using the Kaplan-Meier method, and a Cox proportional hazards model was used to assess potential predictors of outcome. Results: The median time to LR was 6.9 years (range, 2.1 to 37.7 years). Overall, 56 patients (75%) had LR in the retroperitoneum, including 25 (93%) of 27 patients initially managed without retroperitoneal lymph node dissection. The 5-year cancer-specific survival (CSS) was 60% (95% CI, 46% to 71%). Patients who underwent complete surgical resection at time of LR (n = 45) had a 5-year CSS of 79% versus 36% for patients without complete resection (n = 30; P < .0001). The 5-year CSS for chemotherapy-naive patients was significantly greater than patients with a prior history of chemotherapy as part of their initial management (5-year CSS, 93% v 49%, respectively). In multivariable analysis of pretreatment parameters available at the time of LR, the presence of symptoms (hazard ratio [HR] = 4.9) and multifocal disease (HR = 3.0) were associated with an inferior CSS. Conclusion: The data suggest that meticulous control of the retroperitoneum is critical to prevent LR in the retroperitoneum. In multivariable analysis, patients with a symptomatic presentation and those with multifocal disease have a significantly decreased survival. Survival is greatly improved if complete surgical excision of disease is attained. © 2008 by American Society of Clinical Oncology.
Keywords: cancer survival; treatment outcome; disease-free survival; cancer surgery; cancer radiotherapy; lymph node dissection; lymphatic metastasis; proportional hazards models; recurrence; time factors; disease progression; testis tumor; testicular neoplasms; medical oncology; multivariate analysis; neoplasms, germ cell and embryonal; germ cell tumor
Journal Title: Journal of Clinical Oncology
Volume: 26
Issue: 34
ISSN: 0732-183X
Publisher: American Society of Clinical Oncology  
Date Published: 2008-12-01
Start Page: 5524
End Page: 5529
Language: English
DOI: 10.1200/jco.2007.15.7453
PUBMED: 18936477
PROVIDER: scopus
PMCID: PMC2651099
Notes: --- - "Cited By (since 1996): 18" - "Export Date: 17 November 2011" - "CODEN: JCOND" - "Source: Scopus"
Altmetric Score
MSK Authors
  1. Robert Motzer
    790 Motzer
  2. David Scott Sharp
    9 Sharp
  3. Joel Sheinfeld
    202 Sheinfeld
  4. Brett Stewart Carver
    109 Carver
  5. George Bosl
    281 Bosl
  6. Scott Egon Eggener
    35 Eggener