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. 2008 Dec 1;26(34):5524-9.
doi: 10.1200/JCO.2007.15.7453. Epub 2008 Oct 20.

Clinical outcome and predictors of survival in late relapse of germ cell tumor

David S Sharp  1 , Brett S Carver, Scott E Eggener, G Varuni Kondagunta, Robert J Motzer, George J Bosl, Joel Sheinfeld
Affiliations

Clinical outcome and predictors of survival in late relapse of germ cell tumor

David S Sharp et al. J Clin Oncol. .

Abstract

Purpose: Late relapse (LR) of germ cell tumor (GCT) is a well recognized entity associated with poor survival. We report on our experience with LR and determine predictors of survival.

Patients and methods: From 1990 to 2004, 75 patients were managed for LR of GCT at our institution. Clinical and pathologic parameters were reviewed. Estimates of cancer-specific survival were generated using the Kaplan-Meier method, and a Cox proportional hazards model was used to assess potential predictors of outcome.

Results: The median time to LR was 6.9 years (range, 2.1 to 37.7 years). Overall, 56 patients (75%) had LR in the retroperitoneum, including 25 (93%) of 27 patients initially managed without retroperitoneal lymph node dissection. The 5-year cancer-specific survival (CSS) was 60% (95% CI, 46% to 71%). Patients who underwent complete surgical resection at time of LR (n = 45) had a 5-year CSS of 79% versus 36% for patients without complete resection (n = 30; P < .0001). The 5-year CSS for chemotherapy-naive patients was significantly greater than patients with a prior history of chemotherapy as part of their initial management (5-year CSS, 93% v 49%, respectively). In multivariable analysis of pretreatment parameters available at the time of LR, the presence of symptoms (hazard ratio [HR] = 4.9) and multifocal disease (HR = 3.0) were associated with an inferior CSS.

Conclusion: The data suggest that meticulous control of the retroperitoneum is critical to prevent LR in the retroperitoneum. In multivariable analysis, patients with a symptomatic presentation and those with multifocal disease have a significantly decreased survival. Survival is greatly improved if complete surgical excision of disease is attained.

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Figures

Fig 1.
Fig 1.
CONSORT diagram.
Fig 2.
Fig 2.
Kaplan-Meier analysis of cancer-specific survival according to complete resection of late relapse (LR) versus incomplete or no resection of LR.
Fig 3.
Fig 3.
Kaplan-Meier analysis of cancer-specific survival from time of late relapse according to prior chemotherapy.
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