A prognostic model including pre- and postsurgical variables to enhance risk stratification of primary mediastinal nonseminomatous germ cell tumors: The 27-year experience of a referral center

Andrea Necchi, Patrizia Giannatempo, Salvatore Lo Vullo, Elena Farè, Daniele Raggi, Manuela Marongiu, Paolo Scanagatta, Leonardo Duranti, Riccardo Giovannetti, Lara Girelli, Nicola Nicolai, Luigi Piva, Davide Biasoni, Tullio Torelli, Mario Catanzaro, Silvia Stagni, Massimo Maffezzini, Alessandro M. Gianni, Luigi Mariani, Ugo PastorinoRoberto Salvioni

Research output: Contribution to journalArticlepeer-review

Abstract

Background Primary mediastinal germ cell tumors (PMGCTs) poorly benefit from chemotherapy and half of patients die because of disease progression. Enhancing the risk stratification might result in tailoring a more personalized treatment strategy from the time of diagnosis. Patients and Methods Between the years 1985 and 2012, 86 patients with PMGCT were treated at our center. Cox proportional hazards regression analysis was conducted in the population of nonseminomas to examine the prognostic effect of candidate factors on progression-free and OS. OS curves were compared using the Kaplan-Meier method and the log-rank test. Results Mean age was 29.8 years (range, 15-63 years). Twenty-five patients (29.1%) had lung and 8 (9.3%) liver, bone, or brain metastases. Twelve patients (13.9%) received upfront high-dose chemotherapy and 45 patients (52.3%) underwent surgery after chemotherapy. Cox analyses included 61 evaluable primary mediastinal nonseminomatous germ cell tumors (PMNSGCTs). The final model of factors indicating a poor prognosis included the combination of surgery and histological response (overall P =.011) and lung metastases (hazard ratio, 3.03; 95% confidence interval, 1.12-8.15; P =.028). The model showed a bootstrap-corrected Harrel c-statistic for OS of 0.66. A risk stratification model based on the combination of these factors and accounting for a 50% 5-year survival cutoff identified 2 groups (poor prognosis, n = 33 vs. good prognosis, n = 28) with distinct OS curves (P 2 test). Results were limited by small numbers. Conclusion Patients with PMNSGCT included 2 subpopulations with distinct prognosis, and therapeutic improvements are needed for patients with poor-risk features.

Original languageEnglish
Pages (from-to)87-93.e1
JournalClinical Genitourinary Cancer
Volume13
Issue number1
DOIs
Publication statusPublished - Feb 1 2015

Keywords

  • Lung metastases
  • Mediastinal germ cell tumors
  • Pathological response
  • Prognostic factors
  • Surgery

ASJC Scopus subject areas

  • Oncology
  • Urology
  • Medicine(all)

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