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 |
| DOI/URL: | |
| Notes: | --- - "Cited By (since 1996): 18" - "Export Date: 17 November 2011" - "CODEN: JCOND" - "Source: Scopus" |
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