San Francisco, CA USA (UroToday.com) The IGCCCG risk stratification prognosticates survival outcomes well in metastatic testicular germ cell tumor (MT-GCT) and classifies patients into favorable, intermediate, and poor-risk. The group assessed how the initial risk changes over time in those who survived at least 2 years since curative treatment with first-line therapy (conditional survival).
The group included patients eligible for first-line therapy for MT0GCT at 5 tertiary cancer centers from 1990-2012. 2-year conditional overall survival (COS) and conditional disease-free survival (CDFS) at a given time point, defined as the probability of surviving or disease-free for an additional 2 years since the start of first-line treatment. Outcomes were stratified by IGCCCG risk criteria, pathology, and age.
The group identified 942 patients total (IGCCCG risk criteria: favorable 63%, intermediate 19%, and poor 16%). Median follow-up was 99 months (range 56-141). In all patients, 2 year COS increased from 92% (95% CI 91%-94%) at baseline to 98% (95% CI 97%-99%) at 24 months and 2 Y CDFS increased from 83% (95% CI 81%-86%) at baseline to 98% (95% CI 97%099%) at 24 months after diagnosis.
2 year COS changed little in the favorable and intermediate IGCCCG risk group. However, in the poor IGCCCG risk group, COS improved from 71% (95% CI 64%-78%) to 93% (95% CI 89%-98%) at two years. 2-year CDFS improved in all risk groups. In the favorable risk group, it improved from 91% baseline to 95% at 12 months. In the intermediate risk group, it improved from 84% baseline to 95% at 12 months. Finally, in the high-risk group, it improved from 55% baseline to 85% at 12 months.
Baseline IGCCCG risk stratification was not associated with long-term COS or CDFS for patients who survived more than 2 years post therapy. No differences were noted between seminoma or non-seminoma. Patients >40 years age had decreased COS compared to < 40 years in the first 18 months, and then same.
The group concludes that the poor IGCCCG risk patient after 2 years of survival had the same probability of relapse and survival as favorable and intermediate risk patient.
Reported By:
Mohammed Haseebuddin, MD, at the 2016 Genitourinary Cancers Symposium - January 7 - 9, 2016 – San Francisco, CA
Fox Chase Cancer Center, Philadelphia, PA