TY - JOUR
T1 - Risk of residual cancer after complete response following first-line chemotherapy in men with metastatic non-seminomatous germ cell tumour and International Germ Cell Cancer Cooperative Group intermediate/poor prognosis
T2 - A multi-institutional retrospective cohort study
AU - Antonelli, Luca
AU - Ardizzone, Davide
AU - Ravi, Praful
AU - Bagrodia, Aditya
AU - Mego, Michal
AU - Daneshmand, Siamak
AU - Nicolai, Nicola
AU - Nazzani, Sebastiano
AU - Giannatempo, Patrizia
AU - Franza, Andrea
AU - Heidenreich, Axel
AU - Paffenholz, Pia
AU - Saoud, Ragheed
AU - Eggener, Scott
AU - Ho, Matthew
AU - Oswald, Nathaniel
AU - Olson, Kathleen
AU - Tryakin, Alexey
AU - Fedyanin, Mikhail
AU - Naoun, Natacha
AU - Javaud, Christophe
AU - Fizazi, Karim
AU - King, Jennifer M.
AU - Adra, Nabil
AU - Douglawi, Antoin
AU - Cary, Clint
AU - Sweeney, Christopher
AU - Fankhauser, Christian D.
N1 - Publisher Copyright:
© 2023 The Author(s)
PY - 2023/3/1
Y1 - 2023/3/1
N2 - Introduction: Current guidelines recommend surveillance in metastatic non-seminomatous germ cell tumour patients treated with first-line-chemotherapy and a complete clinical response (normalisation of serum tumour markers and residual masses <1 cm). However, this recommendation is based on a series including patients with good prognosis according to International Germ Cell Cancer Cooperative Group prognostic group (IGCCCG-PG). The aim of this study was to analyse the proportion of residual teratoma and survival among patients with intermediate/poor IGCCCG-PG and a complete clinical response after first-line-chemotherapy. Material & methods: This is a retrospective study of men with intermediate/poor IGCCCG-PG, who had a complete clinical response after first-line chemotherapy. Patients were either followed by surveillance or treated with post-chemotherapy retroperitoneal lymph node dissection (pcRPLND). Results: Between 2009 and 2018, 143 men with intermediate (n = 83) or poor (n = 60) IGCCCG-PG were treated at 11 international centres. Among 33 patients treated with pcRPLND, the specimen showed teratoma and viable cancer in 16 (48%) and 4 (12%). During a median a 7-year follow-up, 20/110 (18%) patients managed with surveillance relapsed, of whom seven (6%) had a retroperitoneal-only relapse versus 2/33 patients managed with pcRPLND relapsed. No difference was observed regarding overall survival (OS) among men treated with pcRPLND or surveillance (5-year OS, 93% and 89%, p-value = 0.35). The median time-to-recurrence among men on surveillance was 1.3 years (range: 0.3–9.1), and the most common sites of relapses included retroperitoneum (11%), chest (5%), and bones (4%). Conclusions: While most men with intermediate/poor IGCCCG-PG harbour teratoma/cancer in the retroperitoneum despite a complete response to first-line-chemotherapy, only 6% managed with surveillance relapsed in the retroperitoneum. There was no significant difference in OS between the two groups.
AB - Introduction: Current guidelines recommend surveillance in metastatic non-seminomatous germ cell tumour patients treated with first-line-chemotherapy and a complete clinical response (normalisation of serum tumour markers and residual masses <1 cm). However, this recommendation is based on a series including patients with good prognosis according to International Germ Cell Cancer Cooperative Group prognostic group (IGCCCG-PG). The aim of this study was to analyse the proportion of residual teratoma and survival among patients with intermediate/poor IGCCCG-PG and a complete clinical response after first-line-chemotherapy. Material & methods: This is a retrospective study of men with intermediate/poor IGCCCG-PG, who had a complete clinical response after first-line chemotherapy. Patients were either followed by surveillance or treated with post-chemotherapy retroperitoneal lymph node dissection (pcRPLND). Results: Between 2009 and 2018, 143 men with intermediate (n = 83) or poor (n = 60) IGCCCG-PG were treated at 11 international centres. Among 33 patients treated with pcRPLND, the specimen showed teratoma and viable cancer in 16 (48%) and 4 (12%). During a median a 7-year follow-up, 20/110 (18%) patients managed with surveillance relapsed, of whom seven (6%) had a retroperitoneal-only relapse versus 2/33 patients managed with pcRPLND relapsed. No difference was observed regarding overall survival (OS) among men treated with pcRPLND or surveillance (5-year OS, 93% and 89%, p-value = 0.35). The median time-to-recurrence among men on surveillance was 1.3 years (range: 0.3–9.1), and the most common sites of relapses included retroperitoneum (11%), chest (5%), and bones (4%). Conclusions: While most men with intermediate/poor IGCCCG-PG harbour teratoma/cancer in the retroperitoneum despite a complete response to first-line-chemotherapy, only 6% managed with surveillance relapsed in the retroperitoneum. There was no significant difference in OS between the two groups.
KW - International Germ Cell Cancer Cooperative Group
KW - Non-seminomatous germ cell tumour
KW - Retroperitoneal lymph node dissection
KW - Teratoma
UR - http://www.scopus.com/inward/record.url?scp=85147874293&partnerID=8YFLogxK
U2 - 10.1016/j.ejca.2022.12.032
DO - 10.1016/j.ejca.2022.12.032
M3 - Article
C2 - 36787661
AN - SCOPUS:85147874293
SN - 0959-8049
VL - 182
SP - 144
EP - 154
JO - European Journal of Cancer
JF - European Journal of Cancer
ER -