Treatment of metastatic germ cell cancer (GCC) is based on the International Germ Cell Cancer Collaborative Group (IGCCCG) prognostic classification published in 1997. 5-year survival rates were reported to be 91%, 79%, and 48% for patients with good, intermediate and poor prognosis, respectively. The question arises whether treatment results improved over time due to cumulative experience and whether there is still a need for dose intensification in intermediate and poor risk patients.
The records of all patients (pts) with metastatic GCC treated at two institutions in Munich between 2000 and 2013 were reviewed with regard to time of initial diagnosis, histopathology, stage, tumor marker levels, metastatic spread, type and duration of chemotherapy (CT), and outcome. Progression-free survival (PFS) and overall survival (OS) were estimated with the Kaplan-Meyer method. The Log-rank test was used to compare survival distributions of different groups.
Of 255 patients identified, 30 pts were excluded due to incomplete data. 189 of 225 pts (84%) included into the study were treated as outpatients and 36 (16%) as inpatients. The median age was 35 years, seminoma and nonseminoma were diagnosed in 72 (32%) and 153 (68%) pts, and 204 pts (91%) had a primary gonadal GCC. 175 (78%), 30 (13%) and 20 pts (9%) had good, intermediate and poor prognosis according to the IGCCCG classification system. The vast majority of pts received 3 to 4 cycles of platinum-based CT while primary high-dose CT was applied to 3 pts in the poor prognosis group. The 2-year-PFS of pts with good, intermediate and poor prognosis was 91%, 83% and 37%, and the 5-year-OS was 98%, 96%, and 66%, respectively. There was no significant difference in the 5-year-OS between pts in the good and intermediate prognosis group.
Compared to data from the 1997 IGCCCG classification system, the outcome of pts with metastastic GCC has considerably improved. Notably, no significant differences in the 5-year-OS were observed between pts with good and intermediate prognosis. While the outcome of pts with intermediate-prognosis is excellent, treatment results in the poor-prognosis group are still unsatisfactory.
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All authors have declared no conflicts of interest.