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 journalArticle

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

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Referral and Consultation
Germ Cell and Embryonal Neoplasms
Drug Therapy
Neoplasm Metastasis
Lung
Nonseminomatous germ cell tumor
Disease Progression
Regression Analysis
Confidence Intervals
Bone and Bones
Survival
Liver
Brain
Therapeutics
Population

Keywords

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

ASJC Scopus subject areas

  • Oncology
  • Urology
  • Medicine(all)

Cite this

@article{22f974ba9c3c450eb6a5c31d7c78304c,
title = "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",
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.",
keywords = "Lung metastases, Mediastinal germ cell tumors, Pathological response, Prognostic factors, Surgery",
author = "Andrea Necchi and Patrizia Giannatempo and {Lo Vullo}, Salvatore and Elena Far{\`e} and Daniele Raggi and Manuela Marongiu and Paolo Scanagatta and Leonardo Duranti and Riccardo Giovannetti and Lara Girelli and Nicola Nicolai and Luigi Piva and Davide Biasoni and Tullio Torelli and Mario Catanzaro and Silvia Stagni and Massimo Maffezzini and Gianni, {Alessandro M.} and Luigi Mariani and Ugo Pastorino and Roberto Salvioni",
year = "2015",
month = "2",
day = "1",
doi = "10.1016/j.clgc.2014.06.014",
language = "English",
volume = "13",
pages = "87--93.e1",
journal = "Clinical Genitourinary Cancer",
issn = "1558-7673",
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}

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

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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

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