Improved clinical outcome in recent years for men with metastatic nonseminomatous germ cell tumors Journal Article

Authors: Carver, B. S.; Serio, A. M.; Bajorin, D.; Motzer, R. J.; Stasi, J.; Bosl, G. J.; Vickers, A. J.; Sheinfeld, J.
Article Title: Improved clinical outcome in recent years for men with metastatic nonseminomatous germ cell tumors
Abstract: Purpose: The integration of chemotherapy and surgery for metastatic nonseminomatous germ cell tumors (NSGCT) results in survival rates of greater than 80% overall. We evaluated men undergoing postchemotherapy retroperitoneal lymph node dissection (PC-RPLND) for NSGCT to determine associations between year of treatment and clinical outcome. Patients and Methods: We evaluated 504 men who underwent PC-RPLND from 1989 to 2002 for NSGCT at our center. Data were obtained from our prospective surgical database and a multivariable logistic regression model was constructed to evaluate variables associated with 15-month relapse in 392 patients with complete data. Results: From 1989 to 1997, clinical stage IIa, IIb, IIc, and III NSGCT was seen in 4%, 20%, 23%, and 47% of patients, respectively, compared with 18%, 26%, 11%, and 38%, respectively, from 1998 to 2002 (P < .001). The median prechemotherapy nodal size for 1989 to 1997 and 1998 to 2002 was 5.0 and 3.5 cm, respectively (P < .001). On multivariable analysis, prechemotherapy retroperitoneal nodal size (odds ratio [OR], 1.12; 95% CI, 1.03 to 1.21; P = .005) and presence of visceral metastasis (OR, 2.10; 95% CI, 1.02 to 4.33; P = .04) were significantly associated with 15-month relapse. Men who received a complete RPLND were significantly less likely to experience relapse (OR, 0.22; 95% CI, 0.09 to 0.50; P < .0005). Conclusion: In more recent years, men are presenting with less advanced metastatic NSGCT. This stage migration together with effective therapy has resulted in an improved relapse-free survival. © 2007 by American Society of Clinical Oncology.
Keywords: adult; cancer chemotherapy; cancer survival; controlled study; treatment outcome; disease-free survival; major clinical study; histopathology; cisplatin; cancer risk; cancer staging; drug megadose; outcome assessment; lymph node dissection; lymphatic metastasis; neoplasm staging; lymph node excision; multiple cycle treatment; neoplasm recurrence, local; etoposide; antineoplastic combined chemotherapy protocols; logistic models; clinical assessment; testicular neoplasms; bleomycin; multivariate analysis; neoplasms, germ cell and embryonal; non seminomatous germinoma
Journal Title: Journal of Clinical Oncology
Volume: 25
Issue: 35
ISSN: 0732-183X
Publisher: American Society of Clinical Oncology  
Date Published: 2007-12-10
Start Page: 5603
End Page: 5608
Language: English
DOI: 10.1200/jco.2007.13.6283
PUBMED: 17998544
PROVIDER: scopus
Notes: --- - "Cited By (since 1996): 15" - "Export Date: 17 November 2011" - "CODEN: JCOND" - "Source: Scopus"
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MSK Authors
  1. Dean Bajorin
    416 Bajorin
  2. Robert Motzer
    769 Motzer
  3. Andrew J Vickers
    565 Vickers
  4. Joel Sheinfeld
    197 Sheinfeld
  5. Angel M Cronin
    145 Cronin
  6. Brett Stewart Carver
    109 Carver
  7. George Bosl
    270 Bosl
  8. Jason Stasi
    25 Stasi