Long-term outcome of chemotherapy for advanced testicular and extragonadal germ cell tumors: a single-center 27-year experience.
OBJECTIVE
We retrospectively assessed long-term outcomes of chemotherapy for advanced germ cell tumors (GCTs) at our institution.


METHODS
Ninety-five consecutive males with advanced GCTs of the testis or extragonadal origin who received chemotherapy between 1980 and 2006 were enrolled. All patients underwent induction chemotherapy including cisplatin.


RESULTS
The median follow-up period was 36.1 months (0 - 288.5) for all patients and 52.6 months (2.2 - 288.5) for the 73 current survivors. Totally, 75 patients (78.9%) achieved complete remission (CR). CR was achieved in 61.1%, 37.9% and 75.0% of the patients after induction therapy, second-line therapy and third-line or more, respectively. As salvage therapy, high-dose chemotherapy was performed in 11 patients (11.7%) and regimens with novel anticancer agents such as paclitaxel and irinotecan were employed for 8 patients (8.5%) from 2003 and later. The era of the treatment, extrapulmonary metastasis and serum alpha-fetoprotein were independent prognostic factors for patients. The 5-year overall survival of patients after 1992 was 83.0%, which was significantly higher than that of those before 1992 (56.3%). CR was never achieved in 20 patients and most of them met the criteria of the poor-prognosis group. Disease recurrence after CR was found in nine patients who were initially classified into the good- or intermediate-prognosis group.


CONCLUSIONS
Improvement of medical management during chemotherapy and the development of several regimens for salvage chemotherapy seemed to contribute to improving outcomes of patients with advanced testicular cancer. Newly established chemotherapy regimens are needed for improvement of survival of patients in the poor-prognosis group.
Department of Urology, Sapporo Medical University, S-1, W-16, Chuo-ku, Sapporo, Hokkaido 060-8543, Japan. zappa@pop12.odn.ne.jp
Toshiaki
T
Tanaka
Hiroshi
H
Kitamura
Atsushi
A
Takahashi
Naoya
N
Masumori
Taiji
T
Tsukamoto
D000293:Adolescent; D000328:Adult; D000970:Antineoplastic Agents / Q000627:therapeutic use*; D002945:Cisplatin / Q000627:therapeutic use*; D004701:Endocrine Gland Neoplasms / Q000188:drug therapy* / Q000401:mortality; D005500:Follow-Up Studies; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D009373:Neoplasms, Germ Cell and Embryonal / Q000188:drug therapy* / Q000401:mortality; D012008:Recurrence; D012189:Retrospective Studies; D013736:Testicular Neoplasms / Q000188:drug therapy* / Q000401:mortality; D016896:Treatment Outcome; D055815:Young Adult
D000970:Antineoplastic Agents; D002945:Cisplatin