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 language | English |
|---|---|
| Pages (from-to) | 87-93.e1 |
| Journal | Clinical Genitourinary Cancer |
| Volume | 13 |
| Issue number | 1 |
| DOIs | |
| Publication status | Published - Feb 1 2015 |
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Keywords
- Lung metastases
- Mediastinal germ cell tumors
- Pathological response
- Prognostic factors
- Surgery
ASJC Scopus subject areas
- Oncology
- Urology
- Medicine(all)
Cite this
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. / Necchi, Andrea; Giannatempo, Patrizia; Lo Vullo, Salvatore; Farè, Elena; Raggi, Daniele; Marongiu, Manuela; Scanagatta, Paolo; Duranti, Leonardo; Giovannetti, Riccardo; Girelli, Lara; Nicolai, Nicola; Piva, Luigi; Biasoni, Davide; Torelli, Tullio; Catanzaro, Mario; Stagni, Silvia; Maffezzini, Massimo; Gianni, Alessandro M.; Mariani, Luigi; Pastorino, Ugo; Salvioni, Roberto.
In: Clinical Genitourinary Cancer, Vol. 13, No. 1, 01.02.2015, p. 87-93.e1.Research output: Contribution to journal › Article
}
TY - JOUR
T1 - A prognostic model including pre- and postsurgical variables to enhance risk stratification of primary mediastinal nonseminomatous germ cell tumors
T2 - The 27-year experience of a referral center
AU - Necchi, Andrea
AU - Giannatempo, Patrizia
AU - Lo Vullo, Salvatore
AU - Farè, Elena
AU - Raggi, Daniele
AU - Marongiu, Manuela
AU - Scanagatta, Paolo
AU - Duranti, Leonardo
AU - Giovannetti, Riccardo
AU - Girelli, Lara
AU - Nicolai, Nicola
AU - Piva, Luigi
AU - Biasoni, Davide
AU - Torelli, Tullio
AU - Catanzaro, Mario
AU - Stagni, Silvia
AU - Maffezzini, Massimo
AU - Gianni, Alessandro M.
AU - Mariani, Luigi
AU - Pastorino, Ugo
AU - Salvioni, Roberto
PY - 2015/2/1
Y1 - 2015/2/1
N2 - 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.
AB - 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.
KW - Lung metastases
KW - Mediastinal germ cell tumors
KW - Pathological response
KW - Prognostic factors
KW - Surgery
UR - http://www.scopus.com/inward/record.url?scp=84920575359&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=84920575359&partnerID=8YFLogxK
U2 - 10.1016/j.clgc.2014.06.014
DO - 10.1016/j.clgc.2014.06.014
M3 - Article
C2 - 25044148
AN - SCOPUS:84920575359
VL - 13
SP - 87-93.e1
JO - Clinical Genitourinary Cancer
JF - Clinical Genitourinary Cancer
SN - 1558-7673
IS - 1
ER -