TY - JOUR
T1 - Survival and New Prognosticators in Metastatic Seminoma
T2 - Results From the IGCCCG-Update Consortium
AU - International Germ Cell Cancer Classification Update Consortium
AU - Beyer, Jörg
AU - Collette, Laurence
AU - Sauvé, Nicolas
AU - Daugaard, Gedske
AU - Feldman, Darren R
AU - Tandstad, Torgrim
AU - Tryakin, Alexey
AU - Stahl, Olof
AU - Gonzalez-Billalabeitia, Enrique
AU - De Giorgi, Ugo
AU - Culine, Stéphane
AU - de Wit, Ronald
AU - Hansen, Aaron R
AU - Bebek, Marko
AU - Terbuch, Angelika
AU - Albany, Costantine
AU - Hentrich, Marcus
AU - Gietema, Jourik A
AU - Negaard, Helene
AU - Huddart, Robert A
AU - Lorch, Anja
AU - Cafferty, Fay H
AU - Heng, Daniel Y C
AU - Sweeney, Christopher J
AU - Winquist, Eric
AU - Chovanec, Michal
AU - Fankhauser, Christian
AU - Stark, Daniel
AU - Grimison, Peter
AU - Necchi, Andrea
AU - Tran, Ben
AU - Heidenreich, Axel
AU - Shamash, Jonathan
AU - Sternberg, Cora N
AU - Vaughn, David J
AU - Duran, Ignacio
AU - Bokemeyer, Carsten
AU - Patrikidou, Anna
AU - Cathomas, Richard
AU - Assele, Samson
AU - Gillessen, Silke
PY - 2021/5/10
Y1 - 2021/5/10
N2 - PURPOSE: The classification of the International Germ-Cell Cancer Collaborative Group (IGCCCG) has been a major advance in the management of germ-cell tumors, but relies on data of only 660 patients with seminoma treated between 1975 and 1990. We re-evaluated this classification in a database from a large international consortium.MATERIALS AND METHODS: Data on 2,451 men with metastatic seminoma treated with cisplatin- and etoposide-based first-line chemotherapy between 1990 and 2013 were collected from 30 institutions or collaborative groups in Australia, Europe, and North America. Clinical trial and registry data were included. Primary end points were progression-free survival (PFS) and overall survival (OS) calculated from day 1 of treatment. Variables at initial presentation were evaluated for their prognostic impact. Results were validated in an independent validation set of 764 additional patients.RESULTS: Compared with the initial IGCCCG classification, in our modern series, 5-year PFS improved from 82% to 89% (95% CI, 87 to 90) and 5-year OS from 86% to 95% (95% CI, 94 to 96) in good prognosis, and from 67% to 79% (95% CI, 70 to 85) and 72% to 88% (95% CI, 80 to 93) in intermediate prognosis patients. Lactate dehydrogenase (LDH) proved to be an additional adverse prognostic factor. Good prognosis patients with LDH above 2.5× upper limit of normal had a 3-year PFS of 80% (95% CI, 75 to 84) and a 3-year OS of 92% (95% CI, 88 to 95) versus 92% (95% CI, 90 to 94) and 97% (95% CI, 96 to 98) in the group with lower LDH.CONCLUSION: PFS and OS in metastatic seminoma significantly improved in our modern series compared with the original data. The original IGCCCG classification retains its relevance, but can be further refined by adding LDH at a cutoff of 2.5× upper limit of normal as an additional adverse prognostic factor.
AB - PURPOSE: The classification of the International Germ-Cell Cancer Collaborative Group (IGCCCG) has been a major advance in the management of germ-cell tumors, but relies on data of only 660 patients with seminoma treated between 1975 and 1990. We re-evaluated this classification in a database from a large international consortium.MATERIALS AND METHODS: Data on 2,451 men with metastatic seminoma treated with cisplatin- and etoposide-based first-line chemotherapy between 1990 and 2013 were collected from 30 institutions or collaborative groups in Australia, Europe, and North America. Clinical trial and registry data were included. Primary end points were progression-free survival (PFS) and overall survival (OS) calculated from day 1 of treatment. Variables at initial presentation were evaluated for their prognostic impact. Results were validated in an independent validation set of 764 additional patients.RESULTS: Compared with the initial IGCCCG classification, in our modern series, 5-year PFS improved from 82% to 89% (95% CI, 87 to 90) and 5-year OS from 86% to 95% (95% CI, 94 to 96) in good prognosis, and from 67% to 79% (95% CI, 70 to 85) and 72% to 88% (95% CI, 80 to 93) in intermediate prognosis patients. Lactate dehydrogenase (LDH) proved to be an additional adverse prognostic factor. Good prognosis patients with LDH above 2.5× upper limit of normal had a 3-year PFS of 80% (95% CI, 75 to 84) and a 3-year OS of 92% (95% CI, 88 to 95) versus 92% (95% CI, 90 to 94) and 97% (95% CI, 96 to 98) in the group with lower LDH.CONCLUSION: PFS and OS in metastatic seminoma significantly improved in our modern series compared with the original data. The original IGCCCG classification retains its relevance, but can be further refined by adding LDH at a cutoff of 2.5× upper limit of normal as an additional adverse prognostic factor.
KW - GERM-CELL CANCER
KW - CHEMOTHERAPY
KW - CISPLATIN
U2 - 10.1200/JCO.20.03292
DO - 10.1200/JCO.20.03292
M3 - Article
C2 - 33729863
SN - 0732-183X
VL - 39
SP - 1553
EP - 1562
JO - Journal of clinical oncology : official journal of the American Society of Clinical Oncology
JF - Journal of clinical oncology : official journal of the American Society of Clinical Oncology
IS - 14
ER -