title: Prognostic factors in patients with poor-risk germ-cell tumors: a retrospective analysis of the Indiana University experience from 1990 to 2014.
abstract: Based on the risk stratification from the International Germ Cell Cancer Collaborative Group (IGCCCG), only 14% of patients with metastatic germ-cell tumors (GCT) had poor-risk disease with a 5-year progression-free survival (PFS) rate of 41% and a 5-year overall survival (OS) rate of only 48%. This analysis attempts to identify prognostic factors for patients with poor-risk disease.
  
  
  
  We conducted a retrospective analysis of all patients with GCT diagnosed and treated at Indiana University from 1990 to 2014. Clinical and pathological characteristics were available for all patients and all of them were treated with cisplatin-etoposide-based chemotherapy. Cox proportional hazards models were used to target significant predictors of disease progression and mortality. A significance level of 5% was used in the analysis.
  
  
  
  We identified 273 consecutive patients with poor-risk GCT (PRGCT). Median follow-up time was 8 years (range 0.03-24.5). The 5-year PFS and OS rates were 58% [95% confidence interval (CI) 51% to 63%] and 73% (95% CI 67% to 78%), respectively. In multivariate survival analyses, multiple risk factors were associated with disease progression, including liver metastasis, brain metastasis, primary mediastinal nonseminomatous GCT (PMNSGCT), and elevation in logarithmic β-hCG. Significant predictors of mortality were PMNSGCT [hazard ratio (HR) 4.63, 95% CI 2.25-9.56; P < 0.001], brain metastasis (HR 3.30, 95% CI 1.74-6.23; P < 0.001), and increasing age (HR 1.03, 95% CI 1.01-1.06; P = 0.02).
  
  
  
  Patients with PMNSGCT, brain metastasis, or with increasing age are at higher risk of death than their counterparts. This contemporary cohort (1990-2014) of 273 patients with PRGCT had improved PFS and OS outcomes than those from the historical IGCCCG group of patients (1975-1990).
authors: Division of Hematology/Oncology and Biostatistics, Melvin & Bren Simon Cancer Center, Indiana University School of Medicine, Indianapolis, USA.
authors: N
authors: N
authors: Adra
authors: Division of Hematology/Oncology and Biostatistics, Melvin & Bren Simon Cancer Center, Indiana University School of Medicine, Indianapolis, USA.
authors: S K
authors: SK
authors: Althouse
authors: Division of Hematology/Oncology and Biostatistics, Melvin & Bren Simon Cancer Center, Indiana University School of Medicine, Indianapolis, USA.
authors: H
authors: H
authors: Liu
authors: Division of Hematology/Oncology and Biostatistics, Melvin & Bren Simon Cancer Center, Indiana University School of Medicine, Indianapolis, USA.
authors: M J
authors: MJ
authors: Brames
authors: Division of Hematology/Oncology and Biostatistics, Melvin & Bren Simon Cancer Center, Indiana University School of Medicine, Indianapolis, USA.
authors: N H
authors: NH
authors: Hanna
authors: Division of Hematology/Oncology and Biostatistics, Melvin & Bren Simon Cancer Center, Indiana University School of Medicine, Indianapolis, USA.
authors: L H
authors: LH
authors: Einhorn
authors: Division of Hematology/Oncology and Biostatistics, Melvin & Bren Simon Cancer Center, Indiana University School of Medicine, Indianapolis, USA calbany@iu.edu.
authors: C
authors: C
authors: Albany
mesh_terms: D000328:Adult; D001932:Brain Neoplasms / Q000453:epidemiology* / Q000473:pathology / Q000556:secondary; D018572:Disease-Free Survival; D005260:Female; D006801:Humans; D007196:Indiana; D008297:Male; D008479:Mediastinal Neoplasms / Q000453:epidemiology* / Q000473:pathology; D008875:Middle Aged; D009373:Neoplasms, Germ Cell and Embryonal / Q000453:epidemiology* / Q000473:pathology; D011379:Prognosis; D016016:Proportional Hazards Models; D012189:Retrospective Studies; D012307:Risk Factors; D015996:Survival Rate; D014495:Universities; D055815:Young Adult
keywords: germ-cell tumor; poor-risk germ-cell tumor; poor-risk testicular cancer; primary mediastinal nonseminomatous germ-cell tumor