title: Conditional Survival of Patients With Metastatic Testicular Germ Cell Tumors Treated With First-Line Curative Therapy.
abstract: OBJECTIVE
  The International Germ Cell Cancer Collaborative Group (IGCCCG) criteria prognosticate survival outcomes in metastatic testicular germ cell tumor (MT-GCT), but how the initial risk changes over time for those who survived since curative treatment is unknown.
  
  
  METHODS
  We assessed patients eligible for first-line therapy for MT-GCT at five tertiary cancer centers from 1990 to 2012 for 2-year conditional overall survival (COS) and conditional disease-free survival (CDFS), defined as the probability of surviving, or surviving and being disease free, respectively, for an additional 2 years at a given time point since the initial diagnosis.
  
  
  RESULTS
  For all patients (N = 942), 2-year COS increased from 92% (95% CI, 91% to 94%) at 0 months to 98% (95% CI, 97% to 99%), and 2-year CDFS increased from 83% (95% CI, 81% to 86%) at baseline to 98% (95% CI, 97% to 99%) at 24 months after diagnosis. Two-year COS improved by 2% (97% at 0 months, 99% at 24 months) in the IGCCCG favorable-risk group, by 5% (94% at 0 months, 99% at 24 months) in the intermediate-risk group, and by 22% (71% at 0 months to 93% at 24 months) in the poor-risk group. Two-year CDFS improved significantly at 12 months for each risk group (favorable, 91% baseline v 95% at 12 months; intermediate, 84% v 95%; poor, 55% v 85%). Baseline IGCCCG risk stratification was not associated with long-term COS or CDFS for patients who survived to greater than 2 years post therapy. No significant differences in COS and CDFS were noted between seminoma and nonseminoma; patients ≥ 40 years old had inferior 2-year COS from 0 to 12 months, but no differences were noted at 18 months.
  
  
  CONCLUSIONS
  Our data suggest that the concept of conditional survival applies to patients with MT-GCT treated with curative therapy. Patients with MT-GCT who survived and remained disease free more than 2 years after the diagnosis had an excellent chance of staying alive and disease free in additional subsequent years, regardless of the initial IGCCCG risk stratification.
authors.affiliation: Jenny J. Ko, Abbotsford Cancer Agency, Abbotsford, British Columbia; Haocheng Li, University of Calgary; Igor Stukalin, Nimira Alimohamed, and Daniel Y.C. Heng, Tom Baker Cancer Center, Calgary, Alberta; Tehmina Asif, Saskatchewan Cancer Agency, Saskatoon, Saskatchewan; Daphne Day and Philippe L. Bedard, Princess Margaret Cancer Center, Toronto, Ontario, Canada; Brandon Bernard and Christopher J. Sweeney, Dana Farber Cancer Institute, Boston, MA; and Ben Tran and Margaret Lee, Royal Melbourne Hospital, Parkville, Victoria, Australia.
authors.forename: Jenny J
authors.initials: JJ
authors.lastname: Ko
authors.affiliation: Jenny J. Ko, Abbotsford Cancer Agency, Abbotsford, British Columbia; Haocheng Li, University of Calgary; Igor Stukalin, Nimira Alimohamed, and Daniel Y.C. Heng, Tom Baker Cancer Center, Calgary, Alberta; Tehmina Asif, Saskatchewan Cancer Agency, Saskatoon, Saskatchewan; Daphne Day and Philippe L. Bedard, Princess Margaret Cancer Center, Toronto, Ontario, Canada; Brandon Bernard and Christopher J. Sweeney, Dana Farber Cancer Institute, Boston, MA; and Ben Tran and Margaret Lee, Royal Melbourne Hospital, Parkville, Victoria, Australia.
authors.forename: Brandon
authors.initials: B
authors.lastname: Bernard
authors.affiliation: Jenny J. Ko, Abbotsford Cancer Agency, Abbotsford, British Columbia; Haocheng Li, University of Calgary; Igor Stukalin, Nimira Alimohamed, and Daniel Y.C. Heng, Tom Baker Cancer Center, Calgary, Alberta; Tehmina Asif, Saskatchewan Cancer Agency, Saskatoon, Saskatchewan; Daphne Day and Philippe L. Bedard, Princess Margaret Cancer Center, Toronto, Ontario, Canada; Brandon Bernard and Christopher J. Sweeney, Dana Farber Cancer Institute, Boston, MA; and Ben Tran and Margaret Lee, Royal Melbourne Hospital, Parkville, Victoria, Australia.
authors.forename: Ben
authors.initials: B
authors.lastname: Tran
authors.affiliation: Jenny J. Ko, Abbotsford Cancer Agency, Abbotsford, British Columbia; Haocheng Li, University of Calgary; Igor Stukalin, Nimira Alimohamed, and Daniel Y.C. Heng, Tom Baker Cancer Center, Calgary, Alberta; Tehmina Asif, Saskatchewan Cancer Agency, Saskatoon, Saskatchewan; Daphne Day and Philippe L. Bedard, Princess Margaret Cancer Center, Toronto, Ontario, Canada; Brandon Bernard and Christopher J. Sweeney, Dana Farber Cancer Institute, Boston, MA; and Ben Tran and Margaret Lee, Royal Melbourne Hospital, Parkville, Victoria, Australia.
authors.forename: Haocheng
authors.initials: H
authors.lastname: Li
authors.affiliation: Jenny J. Ko, Abbotsford Cancer Agency, Abbotsford, British Columbia; Haocheng Li, University of Calgary; Igor Stukalin, Nimira Alimohamed, and Daniel Y.C. Heng, Tom Baker Cancer Center, Calgary, Alberta; Tehmina Asif, Saskatchewan Cancer Agency, Saskatoon, Saskatchewan; Daphne Day and Philippe L. Bedard, Princess Margaret Cancer Center, Toronto, Ontario, Canada; Brandon Bernard and Christopher J. Sweeney, Dana Farber Cancer Institute, Boston, MA; and Ben Tran and Margaret Lee, Royal Melbourne Hospital, Parkville, Victoria, Australia.
authors.forename: Tehmina
authors.initials: T
authors.lastname: Asif
authors.affiliation: Jenny J. Ko, Abbotsford Cancer Agency, Abbotsford, British Columbia; Haocheng Li, University of Calgary; Igor Stukalin, Nimira Alimohamed, and Daniel Y.C. Heng, Tom Baker Cancer Center, Calgary, Alberta; Tehmina Asif, Saskatchewan Cancer Agency, Saskatoon, Saskatchewan; Daphne Day and Philippe L. Bedard, Princess Margaret Cancer Center, Toronto, Ontario, Canada; Brandon Bernard and Christopher J. Sweeney, Dana Farber Cancer Institute, Boston, MA; and Ben Tran and Margaret Lee, Royal Melbourne Hospital, Parkville, Victoria, Australia.
authors.forename: Igor
authors.initials: I
authors.lastname: Stukalin
authors.affiliation: Jenny J. Ko, Abbotsford Cancer Agency, Abbotsford, British Columbia; Haocheng Li, University of Calgary; Igor Stukalin, Nimira Alimohamed, and Daniel Y.C. Heng, Tom Baker Cancer Center, Calgary, Alberta; Tehmina Asif, Saskatchewan Cancer Agency, Saskatoon, Saskatchewan; Daphne Day and Philippe L. Bedard, Princess Margaret Cancer Center, Toronto, Ontario, Canada; Brandon Bernard and Christopher J. Sweeney, Dana Farber Cancer Institute, Boston, MA; and Ben Tran and Margaret Lee, Royal Melbourne Hospital, Parkville, Victoria, Australia.
authors.forename: Margaret
authors.initials: M
authors.lastname: Lee
authors.affiliation: Jenny J. Ko, Abbotsford Cancer Agency, Abbotsford, British Columbia; Haocheng Li, University of Calgary; Igor Stukalin, Nimira Alimohamed, and Daniel Y.C. Heng, Tom Baker Cancer Center, Calgary, Alberta; Tehmina Asif, Saskatchewan Cancer Agency, Saskatoon, Saskatchewan; Daphne Day and Philippe L. Bedard, Princess Margaret Cancer Center, Toronto, Ontario, Canada; Brandon Bernard and Christopher J. Sweeney, Dana Farber Cancer Institute, Boston, MA; and Ben Tran and Margaret Lee, Royal Melbourne Hospital, Parkville, Victoria, Australia.
authors.forename: Daphne
authors.initials: D
authors.lastname: Day
authors.affiliation: Jenny J. Ko, Abbotsford Cancer Agency, Abbotsford, British Columbia; Haocheng Li, University of Calgary; Igor Stukalin, Nimira Alimohamed, and Daniel Y.C. Heng, Tom Baker Cancer Center, Calgary, Alberta; Tehmina Asif, Saskatchewan Cancer Agency, Saskatoon, Saskatchewan; Daphne Day and Philippe L. Bedard, Princess Margaret Cancer Center, Toronto, Ontario, Canada; Brandon Bernard and Christopher J. Sweeney, Dana Farber Cancer Institute, Boston, MA; and Ben Tran and Margaret Lee, Royal Melbourne Hospital, Parkville, Victoria, Australia.
authors.forename: Nimira
authors.initials: N
authors.lastname: Alimohamed
authors.affiliation: Jenny J. Ko, Abbotsford Cancer Agency, Abbotsford, British Columbia; Haocheng Li, University of Calgary; Igor Stukalin, Nimira Alimohamed, and Daniel Y.C. Heng, Tom Baker Cancer Center, Calgary, Alberta; Tehmina Asif, Saskatchewan Cancer Agency, Saskatoon, Saskatchewan; Daphne Day and Philippe L. Bedard, Princess Margaret Cancer Center, Toronto, Ontario, Canada; Brandon Bernard and Christopher J. Sweeney, Dana Farber Cancer Institute, Boston, MA; and Ben Tran and Margaret Lee, Royal Melbourne Hospital, Parkville, Victoria, Australia.
authors.forename: Christopher J
authors.initials: CJ
authors.lastname: Sweeney
authors.affiliation: Jenny J. Ko, Abbotsford Cancer Agency, Abbotsford, British Columbia; Haocheng Li, University of Calgary; Igor Stukalin, Nimira Alimohamed, and Daniel Y.C. Heng, Tom Baker Cancer Center, Calgary, Alberta; Tehmina Asif, Saskatchewan Cancer Agency, Saskatoon, Saskatchewan; Daphne Day and Philippe L. Bedard, Princess Margaret Cancer Center, Toronto, Ontario, Canada; Brandon Bernard and Christopher J. Sweeney, Dana Farber Cancer Institute, Boston, MA; and Ben Tran and Margaret Lee, Royal Melbourne Hospital, Parkville, Victoria, Australia.
authors.forename: Philippe L
authors.initials: PL
authors.lastname: Bedard
authors.affiliation: Jenny J. Ko, Abbotsford Cancer Agency, Abbotsford, British Columbia; Haocheng Li, University of Calgary; Igor Stukalin, Nimira Alimohamed, and Daniel Y.C. Heng, Tom Baker Cancer Center, Calgary, Alberta; Tehmina Asif, Saskatchewan Cancer Agency, Saskatoon, Saskatchewan; Daphne Day and Philippe L. Bedard, Princess Margaret Cancer Center, Toronto, Ontario, Canada; Brandon Bernard and Christopher J. Sweeney, Dana Farber Cancer Institute, Boston, MA; and Ben Tran and Margaret Lee, Royal Melbourne Hospital, Parkville, Victoria, Australia. daniel.heng@albertahealthservices.ca.
authors.forename: Daniel Y C
authors.initials: DY
authors.lastname: Heng
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002648:Child; D002675:Child, Preschool; D006801:Humans; D008297:Male; D008875:Middle Aged; D009367:Neoplasm Staging; D009373:Neoplasms, Germ Cell and Embryonal / Q000401:mortality* / Q000473:pathology / Q000628:therapy*; D011379:Prognosis; D015996:Survival Rate; D013736:Testicular Neoplasms / Q000401:mortality* / Q000473:pathology / Q000628:therapy*; D016896:Treatment Outcome