title: During twenty years of Cisplatin-based therapy the face of nonseminomatous testicular germ cell tumors is still changing: an evaluation of presentation, management, predictive factors and survival.
abstract: OBJECTIVE
  To assess the changing presentation and treatment of nonseminomatous testicular germ cell tumors (NSGCT) and to investigate predictive factors for the status of metastasis at diagnosis and on relapse and death.
  
  
  METHODS
  Retrospective record review of 147 patients that underwent inguinal orchiectomy from 1987-2007. Follow-up data was available for 102 patients (median follow-up: 80 months (0-243); 96 patients alive).
  
  
  RESULTS
  Mean patients age increased (p = 0.015) and more patients were diagnosed in clinical stage I (CSI) (p = 0.040). The fraction of yolk sac (YS) elements inclined (p = 0.030) and pT2 tumors increased (p < 0.001). Retroperitoneal lymph node dissection (RPLND) declined whereas more patients were treated with chemotherapy (p < 0.001; p = 0.004). There was an increase in relapse free (RFS) and cancer specific survival (CSS) due to an improvement in patients with disseminated disease (p = 0.014; p < 0.001). The presence of YS and teratoma elements showed a reduction in the odds ratio (OR) for metastasis at diagnosis (p = 0.002, OR: 0.262; p = 0.009, OR: 0.428) whereas higher pT-stage was associated to their presence (p = 0.039). Patients with disseminated disease (CS > I) showed a declined CSS compared to CSI patients (p = 0.055). The presence of YS elements was associated to an improved RFS (p = 0.038).
  
  
  CONCLUSIONS
  In our single institution study the face of NSGCT markedly changed over 20 years even after the introduction of Cisplatin-based chemotherapy. These changes were accompanied by an improvement in RFS and CSS. When dealing with NSGCT patients such observations now and in the future should be taken into account.
authors.affiliation: Department of Urology, University Medical Center Mannheim, Medical Faculty Mannheim, University of Heidelberg, 68157 Mannheim, Germany. julia.heinzelbecker@umm.de
authors.forename: Julia
authors.initials: J
authors.lastname: Heinzelbecker
authors.forename: Michaela
authors.initials: M
authors.lastname: Katzmarzik
authors.forename: Christel
authors.initials: C
authors.lastname: Weiss
authors.forename: Lutz
authors.initials: L
authors.lastname: Trojan
authors.forename: Axel
authors.initials: A
authors.lastname: Haecker
mesh_terms: D000970:Antineoplastic Agents / Q000627:therapeutic use*; D002945:Cisplatin / Q000627:therapeutic use*; D018572:Disease-Free Survival; D006801:Humans; D008297:Male; D009367:Neoplasm Staging; D009373:Neoplasms, Germ Cell and Embryonal / Q000188:drug therapy* / Q000401:mortality / Q000556:secondary; D009919:Orchiectomy; D011237:Predictive Value of Tests; D012189:Retrospective Studies; D012307:Risk Factors; D013736:Testicular Neoplasms / Q000188:drug therapy* / Q000401:mortality / Q000556:secondary; D013997:Time Factors
chemical_list: D000970:Antineoplastic Agents; D002945:Cisplatin