title: Is there an intermediate-risk non-seminoma? long-term treatment results from a single center.
abstract: OBJECTIVE
  We retrospectively assessed the treatment results of patients with testicular non-seminoma to evaluate possible predictive and prognostic factors.
  
  
  METHODS
  189 patients with testicular non-seminoma treated between 2000 and 2012 were retrospectively evaluated. Treatment was based on orchiectomy plus chemotherapy (bleomycin/etoposide/cisplatin and vinblastine/ifosfamide/ cisplatin); retroperitoneal lymphadenectomy was only performed for residual disease after chemotherapy. The treatment protocol was updated regularly according to international standards. Overall survival (OS) was evaluated with the Kaplan-Meier method at a significance level of 5% according to stage, Karnofsky performance status (KPS), and chemotherapy dose intensity.
  
  
  RESULTS
  OS differed significantly for patients at different TNM stages (p=0.000); however, detailed analysis revealed significantly worse survival only in stage IIIC (10-year OS for IIIC vs IIIA+B, 35 vs 88%, p=0.001), while the difference between IIIB and lower stages was not significant (p=0.383). Patients with no chemotherapy dose reduction had significantly higher OS than those with any kind of dose reduction (10-year OS 96 vs 0%, p=0.000). For stage IIIC disease, however, dose intensity had no influence on OS (p=0.167). KPS had no prognostic significance for OS (KPS<80 vs ≥80, p=0.627) for stage IIIA+B and for stage IIIC.
  
  
  CONCLUSIONS
  The standard of care for testicular non-seminoma offers excellent prognosis with no significant differences in OS for good- and intermediate-risk patients. Reduction of chemotherapy dose negatively impacted OS in patients with stage IIIA+B and thus should be avoided.
authors.affiliation: Department of Oncology, University Hospital Ostrava, Ostrava, Czech Republic.
authors.forename: Jakub
authors.initials: J
authors.lastname: Cvek
authors.forename: David
authors.initials: D
authors.lastname: Feltl
authors.forename: Jaroslav
authors.initials: J
authors.lastname: Hajek
authors.forename: Jana
authors.initials: J
authors.lastname: Jackaninova
authors.forename: Klara
authors.initials: K
authors.lastname: Ruzickova
authors.forename: Ondrej
authors.initials: O
authors.lastname: Havranek
authors.forename: Jana
authors.initials: J
authors.lastname: Dvorackova
authors.forename: Premysl
authors.initials: P
authors.lastname: Dobes
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D003131:Combined Modality Therapy; D006801:Humans; D008297:Male; D008875:Middle Aged; D009367:Neoplasm Staging; D009373:Neoplasms, Germ Cell and Embryonal / Q000401:mortality / Q000473:pathology / Q000628:therapy*; D012189:Retrospective Studies; D012306:Risk; D013736:Testicular Neoplasms / Q000401:mortality / Q000473:pathology / Q000628:therapy*