title: Outcome of patients with stage II and III nonseminomatous germ cell tumors: results of a single center.
abstract: BACKGROUND
  The prognostic factors in nonseminomatous germ cell tumors have been mainly derived from the analysis of stage I tumors.
  
  
  OBJECTIVE
  The aim of this study was to evaluate some prognostic factors and the outcome of patients with stage II and III nonseminomatous germ cell tumors according to risk groups treated between 1993 and 2002.
  
  
  METHODS
  Patients were retrospectively classified as good, intermediate and poor risk groups according to International Germ Cell Cancer Consensus Group.
  
  
  METHODS
  Biopsy specimens of 58 patients with stage II and III nonseminomatous germ cell tumors were analyzed by means of tumor histopathology, primary localization site of the tumor, relapse sites, initial serum tumor marker levels, the presence of persistent serum tumor marker elevation and the patients' outcome.
  
  
  METHODS
  Kruskall Wallis test and Mann-Whitney U test were used to determine the differences between the groups. Kaplan-Meier method was used for survival analysis and log rank test was used to compare the survival probabilities of groups. Cox proportional hazard analysis was used to determine the prognostic factors in univariate and multivariate analysis.
  
  
  RESULTS
  Five-year overall and disease-free survival rates were calculated as 85% and 75% in stage II; 44% and 29% in stage III cases, respectively. Fifty-seven percent of patients were classified in good risk, 9% in intermediate risk and 27% in poor risk groups. Five-year overall survival rates were 97%, 75% and 7% (P<0.001) and disease-free survival rates were 83%, 34% and 7% (P<0.001) in good, intermediate and poor risk groups, respectively. Analysis of the prognostic factors revealed that the localization site of the primary tumor (P<0.001), the initial beta-HCG level (p:0.0048), the presence of yolk sac and choriocarcinoma components in tumor (p:0.003 and p:0.004), relapse sites of tumor (lung versus other than lung) (p:0.003), persistent elevation of serum tumor markers (P<0.001) were significant prognostic factors in univariate analysis. However, in multivariate analysis, only the localization site of tumor (p:0.049) and the relapse site (p:0.003) were found statistically significant.
  
  
  CONCLUSIONS
  This retrospective study revealed that in advanced stage of nonseminomatous germ cell tumors, the outcome is essentially related with the localization site of the tumor and the relapse site.
authors.affiliation: Gulhane Faculty of Medicine, Department of Medical Oncology, Ankara, Turkey. sataergin@superonline.com
authors.forename: S
authors.initials: S
authors.lastname: Ataergin
authors.forename: A
authors.initials: A
authors.lastname: Ozet
authors.forename: F
authors.initials: F
authors.lastname: Arpaci
authors.forename: S
authors.initials: S
authors.lastname: Kilic
authors.forename: M
authors.initials: M
authors.lastname: Beyzadeoglu
authors.forename: S
authors.initials: S
authors.lastname: Komurcu
mesh_terms: D000328:Adult; D014408:Biomarkers, Tumor / Q000378:metabolism*; D018236:Carcinoma, Embryonal / Q000378:metabolism / Q000473:pathology; D018997:Chorionic Gonadotropin, beta Subunit, Human / Q000378:metabolism; D018572:Disease-Free Survival; D006801:Humans; D008297:Male; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000378:metabolism / Q000473:pathology; D009367:Neoplasm Staging; D009373:Neoplasms, Germ Cell and Embryonal / Q000378:metabolism / Q000473:pathology*; D011379:Prognosis; D012186:Retroperitoneal Neoplasms / Q000378:metabolism / Q000473:pathology; D012189:Retrospective Studies; D015996:Survival Rate; D013736:Testicular Neoplasms / Q000378:metabolism / Q000473:pathology; D016896:Treatment Outcome; D000509:alpha-Fetoproteins / Q000378:metabolism
chemical_list: D014408:Biomarkers, Tumor; D018997:Chorionic Gonadotropin, beta Subunit, Human; D000509:alpha-Fetoproteins