Prognostic variables for response and outcome in patients with extragonadal germ-cell tumors

Lawrence Einhorn, J. T. Hartmann, C. R. Nichols, C. Bokemeyer, J. P. Droz, A. Horwich, A. Gerl, S. D. Fossa, J. Beyer, J. Pont, L. Kanz

Research output: Contribution to journalArticle

77 Citations (Scopus)

Abstract

Background: This investigation evaluates prognostic variables in patients with seminomatous and non-seminomatous extragonadal germ-cell tumors (EGCT) in order to identify relevant factors for long-term outcome following cisplatin-based chemotherapy. Patients and methods: Patients from six countries treated at 11 centers in Europe and the USA from 1975 to 1996 were evaluated retrospectively. Uni- and multivariate analyses of prognostic variables for survival and for response to chemotherapy were performed. Results: Data were available for 635 EGCT patients, 104 with seminomatous and 524 with non-seminomatous EGCT (n = 7 not specified). For non-seminomatous EGCT the following independent adverse factors were identified: presence of either liver, lung or central nervous system metastases, primary mediastinal tumor or elevation of pretreatment β-human gonadotropin; for extragonadal seminoma (only univariate) adverse factors were: presence of liver metastases, two or greater metastatic sites or International Germ Cell Cancer Collaborative Group (IGCCCG) grouping (intermediate versus good). Integration of these variables produced the following prognostic risk grouping: 'excellent prognosis', all seminomatous EGCT (89% 5-year survival rate); 'intermediate low', 'intermediate high' and 'poor', all non-seminomatous EGCT with a 69, 55 and 17% 5-year survival rate, respectively. The decreased survival among the different groups was due to a lower rate of favorable objective remissions and a higher rate of relapses. Classification and regression tree (CART) modeling confirmed histology and location of primary tumor as the major prognosticators. For the subgroup of patients with mediastinal non-seminoma, the 2-year survival rate ranged from 34 to 84%. Multivariate testing for the probability to respond to chemotherapy revealed non-seminomatous histology, primary mediastinal tumor site, and the presence of liver, lung or CNS metastases as independent adverse factors. Conclusions: In EGCT, prognostic variables for the outcome and for the response to chemotherapy could be identified, which in part differ from gonadal GCT. The proposed model might help to better understand the specific prognosis of EGCT and to tailor risk-adapted treatment strategies. In addition, CART analysis demonstrated the heterogenous prognosis of patients with mediastinal non-seminoma.

Original languageEnglish
Pages (from-to)1017-1028
Number of pages12
JournalAnnals of Oncology
Volume13
Issue number7
DOIs
StatePublished - 2002

Fingerprint

Germ Cell and Embryonal Neoplasms
Drug Therapy
Survival Rate
Neoplasm Metastasis
Liver
Histology
Neoplasms
Lung
Seminoma
Survival
Gonadotropins
Cisplatin
Multivariate Analysis
Central Nervous System
Regression Analysis
Recurrence
Nonseminomatous germ cell tumor

Keywords

  • Chemotherapy
  • Extragonadal germ-cell tumors
  • Mediastinal location
  • Prognostic variables
  • Response
  • Retroperitoneal location

ASJC Scopus subject areas

  • Oncology
  • Cancer Research

Cite this

Einhorn, L., Hartmann, J. T., Nichols, C. R., Bokemeyer, C., Droz, J. P., Horwich, A., ... Kanz, L. (2002). Prognostic variables for response and outcome in patients with extragonadal germ-cell tumors. Annals of Oncology, 13(7), 1017-1028. https://doi.org/10.1093/annonc/mdf176

Prognostic variables for response and outcome in patients with extragonadal germ-cell tumors. / Einhorn, Lawrence; Hartmann, J. T.; Nichols, C. R.; Bokemeyer, C.; Droz, J. P.; Horwich, A.; Gerl, A.; Fossa, S. D.; Beyer, J.; Pont, J.; Kanz, L.

In: Annals of Oncology, Vol. 13, No. 7, 2002, p. 1017-1028.

Research output: Contribution to journalArticle

Einhorn, L, Hartmann, JT, Nichols, CR, Bokemeyer, C, Droz, JP, Horwich, A, Gerl, A, Fossa, SD, Beyer, J, Pont, J & Kanz, L 2002, 'Prognostic variables for response and outcome in patients with extragonadal germ-cell tumors', Annals of Oncology, vol. 13, no. 7, pp. 1017-1028. https://doi.org/10.1093/annonc/mdf176
Einhorn, Lawrence ; Hartmann, J. T. ; Nichols, C. R. ; Bokemeyer, C. ; Droz, J. P. ; Horwich, A. ; Gerl, A. ; Fossa, S. D. ; Beyer, J. ; Pont, J. ; Kanz, L. / Prognostic variables for response and outcome in patients with extragonadal germ-cell tumors. In: Annals of Oncology. 2002 ; Vol. 13, No. 7. pp. 1017-1028.
@article{99e1ecc15e654880b92f2fa63d729297,
title = "Prognostic variables for response and outcome in patients with extragonadal germ-cell tumors",
abstract = "Background: This investigation evaluates prognostic variables in patients with seminomatous and non-seminomatous extragonadal germ-cell tumors (EGCT) in order to identify relevant factors for long-term outcome following cisplatin-based chemotherapy. Patients and methods: Patients from six countries treated at 11 centers in Europe and the USA from 1975 to 1996 were evaluated retrospectively. Uni- and multivariate analyses of prognostic variables for survival and for response to chemotherapy were performed. Results: Data were available for 635 EGCT patients, 104 with seminomatous and 524 with non-seminomatous EGCT (n = 7 not specified). For non-seminomatous EGCT the following independent adverse factors were identified: presence of either liver, lung or central nervous system metastases, primary mediastinal tumor or elevation of pretreatment β-human gonadotropin; for extragonadal seminoma (only univariate) adverse factors were: presence of liver metastases, two or greater metastatic sites or International Germ Cell Cancer Collaborative Group (IGCCCG) grouping (intermediate versus good). Integration of these variables produced the following prognostic risk grouping: 'excellent prognosis', all seminomatous EGCT (89{\%} 5-year survival rate); 'intermediate low', 'intermediate high' and 'poor', all non-seminomatous EGCT with a 69, 55 and 17{\%} 5-year survival rate, respectively. The decreased survival among the different groups was due to a lower rate of favorable objective remissions and a higher rate of relapses. Classification and regression tree (CART) modeling confirmed histology and location of primary tumor as the major prognosticators. For the subgroup of patients with mediastinal non-seminoma, the 2-year survival rate ranged from 34 to 84{\%}. Multivariate testing for the probability to respond to chemotherapy revealed non-seminomatous histology, primary mediastinal tumor site, and the presence of liver, lung or CNS metastases as independent adverse factors. Conclusions: In EGCT, prognostic variables for the outcome and for the response to chemotherapy could be identified, which in part differ from gonadal GCT. The proposed model might help to better understand the specific prognosis of EGCT and to tailor risk-adapted treatment strategies. In addition, CART analysis demonstrated the heterogenous prognosis of patients with mediastinal non-seminoma.",
keywords = "Chemotherapy, Extragonadal germ-cell tumors, Mediastinal location, Prognostic variables, Response, Retroperitoneal location",
author = "Lawrence Einhorn and Hartmann, {J. T.} and Nichols, {C. R.} and C. Bokemeyer and Droz, {J. P.} and A. Horwich and A. Gerl and Fossa, {S. D.} and J. Beyer and J. Pont and L. Kanz",
year = "2002",
doi = "10.1093/annonc/mdf176",
language = "English",
volume = "13",
pages = "1017--1028",
journal = "Annals of Oncology",
issn = "0923-7534",
publisher = "Oxford University Press",
number = "7",

}

TY - JOUR

T1 - Prognostic variables for response and outcome in patients with extragonadal germ-cell tumors

AU - Einhorn, Lawrence

AU - Hartmann, J. T.

AU - Nichols, C. R.

AU - Bokemeyer, C.

AU - Droz, J. P.

AU - Horwich, A.

AU - Gerl, A.

AU - Fossa, S. D.

AU - Beyer, J.

AU - Pont, J.

AU - Kanz, L.

PY - 2002

Y1 - 2002

N2 - Background: This investigation evaluates prognostic variables in patients with seminomatous and non-seminomatous extragonadal germ-cell tumors (EGCT) in order to identify relevant factors for long-term outcome following cisplatin-based chemotherapy. Patients and methods: Patients from six countries treated at 11 centers in Europe and the USA from 1975 to 1996 were evaluated retrospectively. Uni- and multivariate analyses of prognostic variables for survival and for response to chemotherapy were performed. Results: Data were available for 635 EGCT patients, 104 with seminomatous and 524 with non-seminomatous EGCT (n = 7 not specified). For non-seminomatous EGCT the following independent adverse factors were identified: presence of either liver, lung or central nervous system metastases, primary mediastinal tumor or elevation of pretreatment β-human gonadotropin; for extragonadal seminoma (only univariate) adverse factors were: presence of liver metastases, two or greater metastatic sites or International Germ Cell Cancer Collaborative Group (IGCCCG) grouping (intermediate versus good). Integration of these variables produced the following prognostic risk grouping: 'excellent prognosis', all seminomatous EGCT (89% 5-year survival rate); 'intermediate low', 'intermediate high' and 'poor', all non-seminomatous EGCT with a 69, 55 and 17% 5-year survival rate, respectively. The decreased survival among the different groups was due to a lower rate of favorable objective remissions and a higher rate of relapses. Classification and regression tree (CART) modeling confirmed histology and location of primary tumor as the major prognosticators. For the subgroup of patients with mediastinal non-seminoma, the 2-year survival rate ranged from 34 to 84%. Multivariate testing for the probability to respond to chemotherapy revealed non-seminomatous histology, primary mediastinal tumor site, and the presence of liver, lung or CNS metastases as independent adverse factors. Conclusions: In EGCT, prognostic variables for the outcome and for the response to chemotherapy could be identified, which in part differ from gonadal GCT. The proposed model might help to better understand the specific prognosis of EGCT and to tailor risk-adapted treatment strategies. In addition, CART analysis demonstrated the heterogenous prognosis of patients with mediastinal non-seminoma.

AB - Background: This investigation evaluates prognostic variables in patients with seminomatous and non-seminomatous extragonadal germ-cell tumors (EGCT) in order to identify relevant factors for long-term outcome following cisplatin-based chemotherapy. Patients and methods: Patients from six countries treated at 11 centers in Europe and the USA from 1975 to 1996 were evaluated retrospectively. Uni- and multivariate analyses of prognostic variables for survival and for response to chemotherapy were performed. Results: Data were available for 635 EGCT patients, 104 with seminomatous and 524 with non-seminomatous EGCT (n = 7 not specified). For non-seminomatous EGCT the following independent adverse factors were identified: presence of either liver, lung or central nervous system metastases, primary mediastinal tumor or elevation of pretreatment β-human gonadotropin; for extragonadal seminoma (only univariate) adverse factors were: presence of liver metastases, two or greater metastatic sites or International Germ Cell Cancer Collaborative Group (IGCCCG) grouping (intermediate versus good). Integration of these variables produced the following prognostic risk grouping: 'excellent prognosis', all seminomatous EGCT (89% 5-year survival rate); 'intermediate low', 'intermediate high' and 'poor', all non-seminomatous EGCT with a 69, 55 and 17% 5-year survival rate, respectively. The decreased survival among the different groups was due to a lower rate of favorable objective remissions and a higher rate of relapses. Classification and regression tree (CART) modeling confirmed histology and location of primary tumor as the major prognosticators. For the subgroup of patients with mediastinal non-seminoma, the 2-year survival rate ranged from 34 to 84%. Multivariate testing for the probability to respond to chemotherapy revealed non-seminomatous histology, primary mediastinal tumor site, and the presence of liver, lung or CNS metastases as independent adverse factors. Conclusions: In EGCT, prognostic variables for the outcome and for the response to chemotherapy could be identified, which in part differ from gonadal GCT. The proposed model might help to better understand the specific prognosis of EGCT and to tailor risk-adapted treatment strategies. In addition, CART analysis demonstrated the heterogenous prognosis of patients with mediastinal non-seminoma.

KW - Chemotherapy

KW - Extragonadal germ-cell tumors

KW - Mediastinal location

KW - Prognostic variables

KW - Response

KW - Retroperitoneal location

UR - http://www.scopus.com/inward/record.url?scp=0035990829&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=0035990829&partnerID=8YFLogxK

U2 - 10.1093/annonc/mdf176

DO - 10.1093/annonc/mdf176

M3 - Article

VL - 13

SP - 1017

EP - 1028

JO - Annals of Oncology

JF - Annals of Oncology

SN - 0923-7534

IS - 7

ER -