Prognostic factors in patients with poor-risk germ-cell tumors: A retrospective analysis of the Indiana University experience from 1990 to 2014

N. Adra, S. K. Althouse, H. Liu, M. J. Brames, Nasser Hanna, Lawrence Einhorn, Costantine Albany

Research output: Contribution to journalArticle

17 Citations (Scopus)

Abstract

Background: Based on the risk stratification from the International Germ Cell Cancer Collaborative Group (IGCCCG), only 14% of patients with metastatic germ-cell tumors (GCT) had poor-risk disease with a 5-year progression-free survival (PFS) rate of 41% and a 5-year overall survival (OS) rate of only 48%. This analysis attempts to identify prognostic factors for patients with poor-risk disease. Patients and methods: We conducted a retrospective analysis of all patients with GCT diagnosed and treated at Indiana University from 1990 to 2014. Clinical and pathological characteristics were available for all patients and all of them were treated with cisplatin-etoposide-based chemotherapy. Cox proportional hazards models were used to target significant predictors of disease progression and mortality. A significance level of 5% was used in the analysis. Results: We identified 273 consecutive patients with poor-risk GCT (PRGCT). Median follow-up time was 8 years (range 0.03-24.5). The 5-year PFS and OS rates were 58% [95% confidence interval (CI) 51% to 63%] and 73% (95% CI 67% to 78%), respectively. In multivariate survival analyses, multiple risk factors were associated with disease progression, including liver metastasis, brain metastasis, primary mediastinal nonseminomatous GCT (PMNSGCT), and elevation in logarithmic ß-hCG. Significant predictors of mortality were PMNSGCT [hazard ratio (HR) 4.63, 95% CI 2.25-9.56; P <0.001], brain metastasis (HR 3.30, 95%CI 1.74-6.23; P <0.001), and increasing age (HR 1.03, 95% CI 1.01-1.06; P=0.02). Conclusions: Patients with PMNSGCT, brain metastasis, or with increasing age are at higher risk of death than their counterparts. This contemporary cohort (1990-2014) of 273 patients with PRGCT had improved PFS and OS outcomes than those from the historical IGCCCG group of patients (1975-1990).

Original languageEnglish (US)
Article number10.1093/annonc/mdw052
Pages (from-to)875-879
Number of pages5
JournalAnnals of Oncology
Volume27
Issue number5
DOIs
StatePublished - May 1 2016

Fingerprint

Germ Cell and Embryonal Neoplasms
Confidence Intervals
Neoplasm Metastasis
Disease-Free Survival
Survival Rate
Disease Progression
Brain
Mortality
Etoposide
Survival Analysis
Proportional Hazards Models
Cisplatin
Multivariate Analysis
Drug Therapy
Survival
Liver

Keywords

  • Germ-cell tumor
  • Poor-risk germ-cell tumor
  • Poor-risk testicular cancer
  • Primary mediastinal nonseminomatous germ-cell tumor

ASJC Scopus subject areas

  • Oncology
  • Hematology

Cite this

Prognostic factors in patients with poor-risk germ-cell tumors : A retrospective analysis of the Indiana University experience from 1990 to 2014. / Adra, N.; Althouse, S. K.; Liu, H.; Brames, M. J.; Hanna, Nasser; Einhorn, Lawrence; Albany, Costantine.

In: Annals of Oncology, Vol. 27, No. 5, 10.1093/annonc/mdw052, 01.05.2016, p. 875-879.

Research output: Contribution to journalArticle

@article{e57b064e0e6148ba8b5eb6fe3e350533,
title = "Prognostic factors in patients with poor-risk germ-cell tumors: A retrospective analysis of the Indiana University experience from 1990 to 2014",
abstract = "Background: Based on the risk stratification from the International Germ Cell Cancer Collaborative Group (IGCCCG), only 14{\%} of patients with metastatic germ-cell tumors (GCT) had poor-risk disease with a 5-year progression-free survival (PFS) rate of 41{\%} and a 5-year overall survival (OS) rate of only 48{\%}. This analysis attempts to identify prognostic factors for patients with poor-risk disease. Patients and methods: We conducted a retrospective analysis of all patients with GCT diagnosed and treated at Indiana University from 1990 to 2014. Clinical and pathological characteristics were available for all patients and all of them were treated with cisplatin-etoposide-based chemotherapy. Cox proportional hazards models were used to target significant predictors of disease progression and mortality. A significance level of 5{\%} was used in the analysis. Results: We identified 273 consecutive patients with poor-risk GCT (PRGCT). Median follow-up time was 8 years (range 0.03-24.5). The 5-year PFS and OS rates were 58{\%} [95{\%} confidence interval (CI) 51{\%} to 63{\%}] and 73{\%} (95{\%} CI 67{\%} to 78{\%}), respectively. In multivariate survival analyses, multiple risk factors were associated with disease progression, including liver metastasis, brain metastasis, primary mediastinal nonseminomatous GCT (PMNSGCT), and elevation in logarithmic {\ss}-hCG. Significant predictors of mortality were PMNSGCT [hazard ratio (HR) 4.63, 95{\%} CI 2.25-9.56; P <0.001], brain metastasis (HR 3.30, 95{\%}CI 1.74-6.23; P <0.001), and increasing age (HR 1.03, 95{\%} CI 1.01-1.06; P=0.02). Conclusions: Patients with PMNSGCT, brain metastasis, or with increasing age are at higher risk of death than their counterparts. This contemporary cohort (1990-2014) of 273 patients with PRGCT had improved PFS and OS outcomes than those from the historical IGCCCG group of patients (1975-1990).",
keywords = "Germ-cell tumor, Poor-risk germ-cell tumor, Poor-risk testicular cancer, Primary mediastinal nonseminomatous germ-cell tumor",
author = "N. Adra and Althouse, {S. K.} and H. Liu and Brames, {M. J.} and Nasser Hanna and Lawrence Einhorn and Costantine Albany",
year = "2016",
month = "5",
day = "1",
doi = "10.1093/annonc/mdw045",
language = "English (US)",
volume = "27",
pages = "875--879",
journal = "Annals of Oncology",
issn = "0923-7534",
publisher = "Oxford University Press",
number = "5",

}

TY - JOUR

T1 - Prognostic factors in patients with poor-risk germ-cell tumors

T2 - A retrospective analysis of the Indiana University experience from 1990 to 2014

AU - Adra, N.

AU - Althouse, S. K.

AU - Liu, H.

AU - Brames, M. J.

AU - Hanna, Nasser

AU - Einhorn, Lawrence

AU - Albany, Costantine

PY - 2016/5/1

Y1 - 2016/5/1

N2 - Background: Based on the risk stratification from the International Germ Cell Cancer Collaborative Group (IGCCCG), only 14% of patients with metastatic germ-cell tumors (GCT) had poor-risk disease with a 5-year progression-free survival (PFS) rate of 41% and a 5-year overall survival (OS) rate of only 48%. This analysis attempts to identify prognostic factors for patients with poor-risk disease. Patients and methods: We conducted a retrospective analysis of all patients with GCT diagnosed and treated at Indiana University from 1990 to 2014. Clinical and pathological characteristics were available for all patients and all of them were treated with cisplatin-etoposide-based chemotherapy. Cox proportional hazards models were used to target significant predictors of disease progression and mortality. A significance level of 5% was used in the analysis. Results: We identified 273 consecutive patients with poor-risk GCT (PRGCT). Median follow-up time was 8 years (range 0.03-24.5). The 5-year PFS and OS rates were 58% [95% confidence interval (CI) 51% to 63%] and 73% (95% CI 67% to 78%), respectively. In multivariate survival analyses, multiple risk factors were associated with disease progression, including liver metastasis, brain metastasis, primary mediastinal nonseminomatous GCT (PMNSGCT), and elevation in logarithmic ß-hCG. Significant predictors of mortality were PMNSGCT [hazard ratio (HR) 4.63, 95% CI 2.25-9.56; P <0.001], brain metastasis (HR 3.30, 95%CI 1.74-6.23; P <0.001), and increasing age (HR 1.03, 95% CI 1.01-1.06; P=0.02). Conclusions: Patients with PMNSGCT, brain metastasis, or with increasing age are at higher risk of death than their counterparts. This contemporary cohort (1990-2014) of 273 patients with PRGCT had improved PFS and OS outcomes than those from the historical IGCCCG group of patients (1975-1990).

AB - Background: Based on the risk stratification from the International Germ Cell Cancer Collaborative Group (IGCCCG), only 14% of patients with metastatic germ-cell tumors (GCT) had poor-risk disease with a 5-year progression-free survival (PFS) rate of 41% and a 5-year overall survival (OS) rate of only 48%. This analysis attempts to identify prognostic factors for patients with poor-risk disease. Patients and methods: We conducted a retrospective analysis of all patients with GCT diagnosed and treated at Indiana University from 1990 to 2014. Clinical and pathological characteristics were available for all patients and all of them were treated with cisplatin-etoposide-based chemotherapy. Cox proportional hazards models were used to target significant predictors of disease progression and mortality. A significance level of 5% was used in the analysis. Results: We identified 273 consecutive patients with poor-risk GCT (PRGCT). Median follow-up time was 8 years (range 0.03-24.5). The 5-year PFS and OS rates were 58% [95% confidence interval (CI) 51% to 63%] and 73% (95% CI 67% to 78%), respectively. In multivariate survival analyses, multiple risk factors were associated with disease progression, including liver metastasis, brain metastasis, primary mediastinal nonseminomatous GCT (PMNSGCT), and elevation in logarithmic ß-hCG. Significant predictors of mortality were PMNSGCT [hazard ratio (HR) 4.63, 95% CI 2.25-9.56; P <0.001], brain metastasis (HR 3.30, 95%CI 1.74-6.23; P <0.001), and increasing age (HR 1.03, 95% CI 1.01-1.06; P=0.02). Conclusions: Patients with PMNSGCT, brain metastasis, or with increasing age are at higher risk of death than their counterparts. This contemporary cohort (1990-2014) of 273 patients with PRGCT had improved PFS and OS outcomes than those from the historical IGCCCG group of patients (1975-1990).

KW - Germ-cell tumor

KW - Poor-risk germ-cell tumor

KW - Poor-risk testicular cancer

KW - Primary mediastinal nonseminomatous germ-cell tumor

UR - http://www.scopus.com/inward/record.url?scp=84964756518&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=84964756518&partnerID=8YFLogxK

U2 - 10.1093/annonc/mdw045

DO - 10.1093/annonc/mdw045

M3 - Article

C2 - 26861605

AN - SCOPUS:84964756518

VL - 27

SP - 875

EP - 879

JO - Annals of Oncology

JF - Annals of Oncology

SN - 0923-7534

IS - 5

M1 - 10.1093/annonc/mdw052

ER -