title: Predictors of outcome in patients with advanced nonseminomatous germ cell testicular tumors.
abstract: BACKGROUND
  Predictor factors determining complete response to treatment are still not clearly defined. We aimed to evaluate clinicopathological features, risk factors, treatment responses, and survival analysis of patient with advanced nonseminomatous GCTs (NSGCTs).
  
  
  METHODS
  Between November 1999 and September 2011, 140 patients with stage II and III NSGCTs were referred to our institutions and 125 patients with complete clinical data were included in this retrospective study. Four cycles of BEP regimen were applied as a first-line treatment. Salvage chemotherapy and/or high-dose chemotherapy (HDCT) with autologous stem cell transplantation were given in patients who progressed after BEP chemotherapy. Post-chemotherapy surgery was performed in selected patients with incomplete radiographic response and normal tumor markers.
  
  
  RESULTS
  The median age was 28 years. For the good, intermediate and poor risk groups, compete response rates (CRR) were, 84.6%, 67.9% and 59.4%, respectively. Extragonadal tumors, stage 3 disease, intermediate and poor risk factors, rete testis invasion were associated with worse outcomes. There were 32 patients (25.6%) with non-CR who were treated with salvage treatment. Thirty-one patients died from GCTs and 94% of them had stage III disease.
  
  
  CONCLUSIONS
  Even though response rates are high, some patients with GCTs still need salvage treatment and cure cannot be achieved. Non-complete response to platinium-based first-line treatment is a negative prognostic factor. Our study confirmed the need for a prognostic and predictive model and more effective salvage approaches.
authors.affiliation: Medical Oncology Department, Namik Kemal University Hospital, Tekirdag, TurkeyE-mail : tyetisyigit@nku.edu.tr.
authors.forename: Tarkan
authors.initials: T
authors.lastname: Yetisyigit
authors.forename: Nalan
authors.initials: N
authors.lastname: Babacan
authors.forename: Yuksel
authors.initials: Y
authors.lastname: Urun
authors.forename: Erdogan Selcuk
authors.initials: ES
authors.lastname: Seber
authors.forename: Sener
authors.initials: S
authors.lastname: Cihan
authors.forename: Erkan
authors.initials: E
authors.lastname: Arpaci
authors.forename: Nuriye
authors.initials: N
authors.lastname: Yildirim
authors.forename: Sercan
authors.initials: S
authors.lastname: Aksoy
authors.forename: Burcin
authors.initials: B
authors.lastname: Budakoglu
authors.forename: Nurullah
authors.initials: N
authors.lastname: Zengin
authors.forename: Berna
authors.initials: B
authors.lastname: Oksuzoglu
authors.forename: Banu Cicek
authors.initials: BC
authors.lastname: Yalcin
authors.forename: Necati
authors.initials: N
authors.lastname: Alkis
mesh_terms: D000293:Adolescent; D000328:Adult; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use*; D001761:Bleomycin / Q000008:administration & dosage; D002945:Cisplatin / Q000008:administration & dosage; D003131:Combined Modality Therapy; D005047:Etoposide / Q000008:administration & dosage; D005500:Follow-Up Studies; D018380:Hematopoietic Stem Cell Transplantation; D006801:Humans; D008297:Male; D008875:Middle Aged; D009362:Neoplasm Metastasis; D009367:Neoplasm Staging; D009373:Neoplasms, Germ Cell and Embryonal / Q000401:mortality / Q000473:pathology / Q000628:therapy*; D011379:Prognosis; D012074:Remission Induction; D012189:Retrospective Studies; D016879:Salvage Therapy; D015996:Survival Rate; D013736:Testicular Neoplasms / Q000401:mortality / Q000473:pathology / Q000628:therapy*; D055815:Young Adult
chemical_list: D001761:Bleomycin; D005047:Etoposide; D002945:Cisplatin