Treatment and Outcome of Patients with Stage IS Testicular Cancer: A Retrospective Study from the Spanish Germ Cell Cancer Group

Autor: P. Diz, Alvaro Pinto, V. Quiroga, X. Garcia del Muro, S. Ochenduszko, Josep Guma, Aurora Hernández, Teresa Alonso-Gordoa, N. Sagastibelza, A. Fernández-Aramburo, A. Gómez de Liaño, Alfonso Sánchez-Muñoz, Montserrat Domenech, Javier Sastre, Enrique Gonzalez-Billalabeitia, Ignacio Duran, Pablo Maroto, Jorge Aparicio, J. Terrasa, Sergio Vázquez
Rok vydání: 2019
Předmět:
Adult
Male
Oncology
endocrine system
medicine.medical_specialty
medicine.drug_class
beta subunit
Urology
medicine.medical_treatment
Disease-Free Survival
alpha-fetoproteins
Young Adult
Testicular Neoplasms
Carcinoma
Embryonal
Internal medicine
Antineoplastic Combined Chemotherapy Protocols
Testis
Carcinoma
medicine
Humans
Chorionic Gonadotropin
beta Subunit
Human
chorionic gonadotropin
human
Orchiectomy
Stage (cooking)
Young adult
Testicular cancer
Chemotherapy
urogenital system
business.industry
Retrospective cohort study
Neoplasms
Germ Cell and Embryonal
testicular neoplasms
Spain
alpha-fetoproteins
beta subunit
chorionic gonadotropin
drug therapy
human
testicular neoplasms
medicine.disease
drug therapy
Chemotherapy
Adjuvant
alpha-Fetoproteins
Neoplasm Recurrence
Local
Gonadotropin
business
Follow-Up Studies
Zdroj: JOURNAL OF UROLOGY
r-IIS La Fe. Repositorio Institucional de Producción Científica del Instituto de Investigación Sanitaria La Fe
instname
r-IIB SANT PAU. Repositorio Institucional de Producción Científica del Instituto de Investigación Biomédica Sant Pau
r-FISABIO: Repositorio Institucional de Producción Científica
Fundación para el Fomento de la Investigación Sanitaria y Biomédica de la Comunitat Valenciana (FISABIO)
r-FISABIO. Repositorio Institucional de Producción Científica
ISSN: 1527-3792
0022-5347
DOI: 10.1097/ju.0000000000000366
Popis: Purpose: Stage IS testicular cancer is defined by the persistence of elevated serum tumor markers, including alpha-fetoprotein and/or beta-human chorionic gonadotropin, after orchiectomy without radiological evidence of metastatic disease. Current treatment recommendations include cisplatin based chemotherapy up front but the recommendations are based on limited single center series. Materials and Methods: We retrospectively analyzed clinical and pathological characteristics, and long-term outcomes in 110 patients uniformly treated with primary chemotherapy between 1994 and 2016. The primary objective was to evaluate long-term disease-free survival. We also explored factors associated with the need for additional treatment. Results: The elevated prechemotherapy tumor markers were alpha-fetoprotein in 48% of cases, beta-human chorionic gonadotropin in 14%, and alpha-fetoprotein and beta-human chorionic gonadotropin in 38%. Median alpha-fetoprotein and beta-human chorionic gonadotropin values were 71 ng/ml and 80 mIU/ml, respectively. The IGCCCG (International Germ Cell Cancer Collaborative Group) prognostic classification was good in 94% of cases. Mixed nonseminomatous germ cell tumor was found in 78% of cases. Of the patients 103 achieved a complete response to chemotherapy. In 6 patients radiological signs of progressive disease developed during chemotherapy, while 8 experienced relapse after an initial complete response. At a median followup of 108 months 108 patients were alive and disease-free. Five and 10-year disease-free survival rates were 87% and 85%, respectively. The predominance of embryonal carcinoma in the primary tumor was the only factor associated with the probability of needing additional therapy. Conclusions: Stage IS testicular cancer is more commonly associated with elevated alpha-fetoprotein, an IGCCCG good prognosis and mixed nonseminomatous germ cell tumor. Treatment with cisplatin based chemotherapy leads to cure in most cases. However, a proportion of patients require the integration of additional therapies, including more frequently when embryonal carcinoma is not predominant.
Databáze: OpenAIRE
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