Long-Term Survival of Good-Risk Germ Cell Tumor Patients After Postchemotherapy Retroperitoneal Lymph Node Dissection: A Comparison of BEP × 3 vs. EP × 4 and Treating Institution

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6 Scopus citations

Abstract

The purpose of the study was to determine if survival differences exist between 3 cycles of bleomycin, etoposide, and cisplatin (BEP × 3) versus 4 cycles of etoposide and cisplatin (EP × 4) for good-risk testicular cancer patients. In 223 patients, we found a nonsignificant trend toward improved survival when men were treated with BEP × 3 compared with EP × 4. Background: Patients with International Germ Cell Cancer Collaborative Group (IGCCCG) good-risk testicular cancer might receive either 4 cycles of etoposide and cisplatin (EP × 4) or 3 cycles of bleomycin, etoposide, and cisplatin (BEP × 3). We sought to examine differences in survival after retroperitoneal lymph node dissection (PC-RPLND) between patients who received EP × 4 compared with BEP × 3. Patients and Methods: The Indiana University Testis Cancer database was queried to identify IGCCCG good-risk PC-RPLND patients who received either EP × 4 or BEP × 3 induction chemotherapy. The primary outcome was overall survival (OS). Kaplan–Meier plots were generated for the EP × 4 and BEP × 3 groups and compared using the log rank test. Cox regression analysis was used to determine risk of mortality. Results: A total of 223 patients met inclusion criteria between 1985 and 2011. Induction chemotherapy consisted of EP × 4 in 45 (20%) patients and BEP × 3 in 178 (80%). Most patients (78%) received their chemotherapy at outside institutions and were subsequently referred for PC-RPLND. The location of treating institution did not influence outcomes significantly when similar chemotherapy regimens were compared in this good-risk cohort. The 10-year OS for the EP × 4 and BEP × 3 groups were 91% and 98%, respectively (log rank P <.01). The adjusted risk of death in the EP × 4 group showed a nonsignificant trend of 3 times greater compared with the BEP × 3 group (hazard ratio, 3.1; 95% confidence interval, 0.8-12.0; P =.10). Conclusion: The regimen of BEP × 3 resulted in a trend toward improved survival, however, this did not reach statistical significance. The location of treating institution seems less important in this risk group of patients.

Original languageEnglish (US)
Pages (from-to)e307-e313
JournalClinical Genitourinary Cancer
Volume16
Issue number2
DOIs
StatePublished - Apr 2018

Keywords

  • Bleomycin
  • Lymph node excision
  • Propensity score
  • Survival analysis
  • Testicular neoplasms

ASJC Scopus subject areas

  • Oncology
  • Urology

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