title: Advanced seminoma--treatment results and prognostic factors for survival after first-line, cisplatin-based chemotherapy and for patients with recurrent disease: a single-institution experience in 145 patients.
abstract: BACKGROUND
  Advanced seminoma is a rare clinicopathologic entity. To the authors' knowledge, very few sizeable reports published to date have studied the outcome of patients with advanced seminoma after first-line and salvage therapy, and few have dealt with prognostic factors initially or in patients with recurrent disease.
  
  
  METHODS
  The records of 145 men with advanced seminoma who were treated with cisplatin-based first-line chemotherapy regimens were reviewed. Six patient characteristics, including age, prior radiotherapy, primary tumor site, initial serum lactate dehydrogenase and human chorionic gonadotropin levels, and disease stage, were studied as initial prognostic factors. In patients with recurrent disease, outcome according to the site of recurrence and the salvage treatment was also reviewed.
  
  
  RESULTS
  A complete response was obtained in 130 patients (90%) after cisplatin-based first-line chemotherapy, and the 5-year overall survival rate was 81% (95% confidence interval [95% CI], 73-87%). Nonpulmonary visceral metastasis at diagnosis was the only initial adverse prognostic factor. Thirty-one patients (21%) developed recurrent disease. Recurrence in the liver or the central nervous system was a major adverse prognostic factor, with a 5-year overall survival rate of 7% (95% CI, 1-32%), compared with 58% (95% CI, 33-79%) in patients who had lymph node, lung, or bone recurrences. The only durable complete remission after a liver recurrence was obtained with high-dose chemotherapy followed by autologous stem cell transplantation. All 12 patients who were treated for primary mediastinal seminoma with cisplatin-based chemotherapy alone were long-term disease free survivors.
  
  
  CONCLUSIONS
  Overall, the prognosis of patients with advanced seminoma was good after cisplatin-based, first-line chemotherapy. Metastasis in the liver or the central nervous system, initially or at recurrence, is currently the only proven adverse prognostic factor.
authors.affiliation: Department of Medicine, Institut Gustave Roussy, Villejuif, France.
authors.forename: Dany
authors.initials: D
authors.lastname: Gholam
authors.forename: Karim
authors.initials: K
authors.lastname: Fizazi
authors.forename: Marie-Jose
authors.initials: MJ
authors.lastname: Terrier-Lacombe
authors.forename: Pascale
authors.initials: P
authors.lastname: Jan
authors.forename: Stephane
authors.initials: S
authors.lastname: Culine
authors.forename: Christine
authors.initials: C
authors.lastname: Theodore
mesh_terms: D000328:Adult; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use*; D016543:Central Nervous System Neoplasms / Q000556:secondary; D002945:Cisplatin / Q000008:administration & dosage*; D006801:Humans; D008113:Liver Neoplasms / Q000556:secondary; D008207:Lymphatic Metastasis; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D012189:Retrospective Studies; D018239:Seminoma / Q000188:drug therapy* / Q000401:mortality / Q000556:secondary*; D015996:Survival Rate; D013736:Testicular Neoplasms / Q000188:drug therapy* / Q000401:mortality / Q000473:pathology
chemical_list: D002945:Cisplatin