The prognostic impact of different tumor marker levels in nonseminomatous germ cell tumor patients with intermediate prognosis: A registry of the International Global Germ Cell Tumor Collaborative Group (G3)

Christoph Seidel, Gedske Daugaard, Alexey Tryakin, Andrea Necchi, Gabriella Cohn-Cedermark, Olof Ståhl, Marcus Hentrich, Margarida Brito, Costantine Albany, Fadi Taza, Arthur Gerl, Karin Oechsle, Christoph Oing, Carsten Bokemeyer

Research output: Contribution to journalArticle

Abstract

Background: Germ cell tumor patients with intermediate prognosis (IPGCT) according to the International Germ Cell Cancer Collaborative Group (IGCCCG) classification represent a heterogeneous group with different clinical features. This analysis was performed to investigate the prognostic impact of different tumor marker levels prior to first line chemotherapy within IPGCT. Methods: For this study an international registry for IPGCT was established. Eligibility criteria were intermediate prognosis according to IGCCCG criteria, nonseminomatous histology, male sex, and age ≥ 16 years. Uni- and multivariate analysis were conducted to identify characteristics associated with survival outcomes. Receiver-Operating-Characteristic curve analysis was applied to find cut-off parameters. Five-year overall survival (OS) rate was the primary and 5-year progression-free survival rate the secondary endpoint. Results: This database included 634 IPGCT with a median follow-up of 9.0 years (interquartile range: 14.35). Patients received first line treatment with platinum based chemotherapy, associated with a 5-year OS rate of 87%. The stratification of patients according to AFP levels revealed a correlation between AFP levels and outcome, associated with 5-year OS rates of 88% for AFP levels <1,000 IU/ml (n = 303), 89% for 1,000 to 2,000 IU/ml (n = 82), 87% for >2,000 to 6,000 IU/ml (n = 121), and 82% for >6,000 IU/ml (n = 57) prior first course of chemotherapy, respectively (P= 0.013). LDH levels prior fist course of chemotherapy also correlated with outcome associated with 5-year OS rates of 92% for <2 UNL (n = 271), 89% for ≥2 to 3 UNL (n = 85), 78% for >3 to 4 UNL (n = 34), and 77% for >4 UNL (n = 79), respectively (P= 0.03). Different HCG levels prior chemotherapy were not associated with outcome. In multivariable analysis AFP levels >6,000 IU/ml (P= 0.023; hazard ratio HR 2.263) or >1,982 IU/ml (P= 0.031; HR 1.722), and LDH levels >3 UNL (P< 0.001; HR 2.616) were independent prognosticators for OS. Conclusions: Prognostication according to LDH and AFP levels prior chemotherapy could offer a new approach to stratify patients within the intermediate prognosis cohort. According to our findings, patients with AFP values above 6,000 IU/ml or/and LDH > 3 UNL represent an independent high risk cohort. Our results need to be confirmed in the upcoming IGCCCG reclassification.

Original languageEnglish
Pages (from-to)809.e19-809.e25
JournalUrologic Oncology: Seminars and Original Investigations
Volume37
Issue number11
DOIs
Publication statusPublished - Nov 2019

Fingerprint

Germ Cell and Embryonal Neoplasms
Tumor Biomarkers
Registries
Survival Rate
Drug Therapy
Platinum
ROC Curve
Disease-Free Survival
Histology
Multivariate Analysis
Nonseminomatous germ cell tumor
Databases
Survival

Keywords

  • AFP and LDH levels
  • IGCCCG classification
  • Intermediate prognosis
  • Risk factor stratification

ASJC Scopus subject areas

  • Oncology
  • Urology

Cite this

The prognostic impact of different tumor marker levels in nonseminomatous germ cell tumor patients with intermediate prognosis : A registry of the International Global Germ Cell Tumor Collaborative Group (G3). / Seidel, Christoph; Daugaard, Gedske; Tryakin, Alexey; Necchi, Andrea; Cohn-Cedermark, Gabriella; Ståhl, Olof; Hentrich, Marcus; Brito, Margarida; Albany, Costantine; Taza, Fadi; Gerl, Arthur; Oechsle, Karin; Oing, Christoph; Bokemeyer, Carsten.

In: Urologic Oncology: Seminars and Original Investigations, Vol. 37, No. 11, 11.2019, p. 809.e19-809.e25.

Research output: Contribution to journalArticle

Seidel, Christoph ; Daugaard, Gedske ; Tryakin, Alexey ; Necchi, Andrea ; Cohn-Cedermark, Gabriella ; Ståhl, Olof ; Hentrich, Marcus ; Brito, Margarida ; Albany, Costantine ; Taza, Fadi ; Gerl, Arthur ; Oechsle, Karin ; Oing, Christoph ; Bokemeyer, Carsten. / The prognostic impact of different tumor marker levels in nonseminomatous germ cell tumor patients with intermediate prognosis : A registry of the International Global Germ Cell Tumor Collaborative Group (G3). In: Urologic Oncology: Seminars and Original Investigations. 2019 ; Vol. 37, No. 11. pp. 809.e19-809.e25.
@article{56eb48d1ddd94295b433ae34eac4ef01,
title = "The prognostic impact of different tumor marker levels in nonseminomatous germ cell tumor patients with intermediate prognosis: A registry of the International Global Germ Cell Tumor Collaborative Group (G3)",
abstract = "Background: Germ cell tumor patients with intermediate prognosis (IPGCT) according to the International Germ Cell Cancer Collaborative Group (IGCCCG) classification represent a heterogeneous group with different clinical features. This analysis was performed to investigate the prognostic impact of different tumor marker levels prior to first line chemotherapy within IPGCT. Methods: For this study an international registry for IPGCT was established. Eligibility criteria were intermediate prognosis according to IGCCCG criteria, nonseminomatous histology, male sex, and age ≥ 16 years. Uni- and multivariate analysis were conducted to identify characteristics associated with survival outcomes. Receiver-Operating-Characteristic curve analysis was applied to find cut-off parameters. Five-year overall survival (OS) rate was the primary and 5-year progression-free survival rate the secondary endpoint. Results: This database included 634 IPGCT with a median follow-up of 9.0 years (interquartile range: 14.35). Patients received first line treatment with platinum based chemotherapy, associated with a 5-year OS rate of 87{\%}. The stratification of patients according to AFP levels revealed a correlation between AFP levels and outcome, associated with 5-year OS rates of 88{\%} for AFP levels <1,000 IU/ml (n = 303), 89{\%} for 1,000 to 2,000 IU/ml (n = 82), 87{\%} for >2,000 to 6,000 IU/ml (n = 121), and 82{\%} for >6,000 IU/ml (n = 57) prior first course of chemotherapy, respectively (P= 0.013). LDH levels prior fist course of chemotherapy also correlated with outcome associated with 5-year OS rates of 92{\%} for <2 UNL (n = 271), 89{\%} for ≥2 to 3 UNL (n = 85), 78{\%} for >3 to 4 UNL (n = 34), and 77{\%} for >4 UNL (n = 79), respectively (P= 0.03). Different HCG levels prior chemotherapy were not associated with outcome. In multivariable analysis AFP levels >6,000 IU/ml (P= 0.023; hazard ratio HR 2.263) or >1,982 IU/ml (P= 0.031; HR 1.722), and LDH levels >3 UNL (P< 0.001; HR 2.616) were independent prognosticators for OS. Conclusions: Prognostication according to LDH and AFP levels prior chemotherapy could offer a new approach to stratify patients within the intermediate prognosis cohort. According to our findings, patients with AFP values above 6,000 IU/ml or/and LDH > 3 UNL represent an independent high risk cohort. Our results need to be confirmed in the upcoming IGCCCG reclassification.",
keywords = "AFP and LDH levels, IGCCCG classification, Intermediate prognosis, Risk factor stratification",
author = "Christoph Seidel and Gedske Daugaard and Alexey Tryakin and Andrea Necchi and Gabriella Cohn-Cedermark and Olof St{\aa}hl and Marcus Hentrich and Margarida Brito and Costantine Albany and Fadi Taza and Arthur Gerl and Karin Oechsle and Christoph Oing and Carsten Bokemeyer",
year = "2019",
month = "11",
doi = "10.1016/j.urolonc.2019.07.020",
language = "English",
volume = "37",
pages = "809.e19--809.e25",
journal = "Urologic Oncology",
issn = "1078-1439",
publisher = "Elsevier Inc.",
number = "11",

}

TY - JOUR

T1 - The prognostic impact of different tumor marker levels in nonseminomatous germ cell tumor patients with intermediate prognosis

T2 - A registry of the International Global Germ Cell Tumor Collaborative Group (G3)

AU - Seidel, Christoph

AU - Daugaard, Gedske

AU - Tryakin, Alexey

AU - Necchi, Andrea

AU - Cohn-Cedermark, Gabriella

AU - Ståhl, Olof

AU - Hentrich, Marcus

AU - Brito, Margarida

AU - Albany, Costantine

AU - Taza, Fadi

AU - Gerl, Arthur

AU - Oechsle, Karin

AU - Oing, Christoph

AU - Bokemeyer, Carsten

PY - 2019/11

Y1 - 2019/11

N2 - Background: Germ cell tumor patients with intermediate prognosis (IPGCT) according to the International Germ Cell Cancer Collaborative Group (IGCCCG) classification represent a heterogeneous group with different clinical features. This analysis was performed to investigate the prognostic impact of different tumor marker levels prior to first line chemotherapy within IPGCT. Methods: For this study an international registry for IPGCT was established. Eligibility criteria were intermediate prognosis according to IGCCCG criteria, nonseminomatous histology, male sex, and age ≥ 16 years. Uni- and multivariate analysis were conducted to identify characteristics associated with survival outcomes. Receiver-Operating-Characteristic curve analysis was applied to find cut-off parameters. Five-year overall survival (OS) rate was the primary and 5-year progression-free survival rate the secondary endpoint. Results: This database included 634 IPGCT with a median follow-up of 9.0 years (interquartile range: 14.35). Patients received first line treatment with platinum based chemotherapy, associated with a 5-year OS rate of 87%. The stratification of patients according to AFP levels revealed a correlation between AFP levels and outcome, associated with 5-year OS rates of 88% for AFP levels <1,000 IU/ml (n = 303), 89% for 1,000 to 2,000 IU/ml (n = 82), 87% for >2,000 to 6,000 IU/ml (n = 121), and 82% for >6,000 IU/ml (n = 57) prior first course of chemotherapy, respectively (P= 0.013). LDH levels prior fist course of chemotherapy also correlated with outcome associated with 5-year OS rates of 92% for <2 UNL (n = 271), 89% for ≥2 to 3 UNL (n = 85), 78% for >3 to 4 UNL (n = 34), and 77% for >4 UNL (n = 79), respectively (P= 0.03). Different HCG levels prior chemotherapy were not associated with outcome. In multivariable analysis AFP levels >6,000 IU/ml (P= 0.023; hazard ratio HR 2.263) or >1,982 IU/ml (P= 0.031; HR 1.722), and LDH levels >3 UNL (P< 0.001; HR 2.616) were independent prognosticators for OS. Conclusions: Prognostication according to LDH and AFP levels prior chemotherapy could offer a new approach to stratify patients within the intermediate prognosis cohort. According to our findings, patients with AFP values above 6,000 IU/ml or/and LDH > 3 UNL represent an independent high risk cohort. Our results need to be confirmed in the upcoming IGCCCG reclassification.

AB - Background: Germ cell tumor patients with intermediate prognosis (IPGCT) according to the International Germ Cell Cancer Collaborative Group (IGCCCG) classification represent a heterogeneous group with different clinical features. This analysis was performed to investigate the prognostic impact of different tumor marker levels prior to first line chemotherapy within IPGCT. Methods: For this study an international registry for IPGCT was established. Eligibility criteria were intermediate prognosis according to IGCCCG criteria, nonseminomatous histology, male sex, and age ≥ 16 years. Uni- and multivariate analysis were conducted to identify characteristics associated with survival outcomes. Receiver-Operating-Characteristic curve analysis was applied to find cut-off parameters. Five-year overall survival (OS) rate was the primary and 5-year progression-free survival rate the secondary endpoint. Results: This database included 634 IPGCT with a median follow-up of 9.0 years (interquartile range: 14.35). Patients received first line treatment with platinum based chemotherapy, associated with a 5-year OS rate of 87%. The stratification of patients according to AFP levels revealed a correlation between AFP levels and outcome, associated with 5-year OS rates of 88% for AFP levels <1,000 IU/ml (n = 303), 89% for 1,000 to 2,000 IU/ml (n = 82), 87% for >2,000 to 6,000 IU/ml (n = 121), and 82% for >6,000 IU/ml (n = 57) prior first course of chemotherapy, respectively (P= 0.013). LDH levels prior fist course of chemotherapy also correlated with outcome associated with 5-year OS rates of 92% for <2 UNL (n = 271), 89% for ≥2 to 3 UNL (n = 85), 78% for >3 to 4 UNL (n = 34), and 77% for >4 UNL (n = 79), respectively (P= 0.03). Different HCG levels prior chemotherapy were not associated with outcome. In multivariable analysis AFP levels >6,000 IU/ml (P= 0.023; hazard ratio HR 2.263) or >1,982 IU/ml (P= 0.031; HR 1.722), and LDH levels >3 UNL (P< 0.001; HR 2.616) were independent prognosticators for OS. Conclusions: Prognostication according to LDH and AFP levels prior chemotherapy could offer a new approach to stratify patients within the intermediate prognosis cohort. According to our findings, patients with AFP values above 6,000 IU/ml or/and LDH > 3 UNL represent an independent high risk cohort. Our results need to be confirmed in the upcoming IGCCCG reclassification.

KW - AFP and LDH levels

KW - IGCCCG classification

KW - Intermediate prognosis

KW - Risk factor stratification

UR - http://www.scopus.com/inward/record.url?scp=85071698088&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=85071698088&partnerID=8YFLogxK

U2 - 10.1016/j.urolonc.2019.07.020

DO - 10.1016/j.urolonc.2019.07.020

M3 - Article

C2 - 31494007

AN - SCOPUS:85071698088

VL - 37

SP - 809.e19-809.e25

JO - Urologic Oncology

JF - Urologic Oncology

SN - 1078-1439

IS - 11

ER -