Prognostic factors and survival in germ cell cancer (GCC) patients treated with bleomycin, etoposide, and cisplatin (BEP): A population-based study

Background

The prognostic classification applied in disseminated GCC was established in 1997, based on patients treated with cisplatin containing regimens. Only a minority of the patients were treated with BEP. We aimed to estimate overall survival (OS) and propose new prognostic factors for GCC patients treated with first line BEP.

Methods

From the nationwide Danish Testicular Cancer database, a total of 1889 BEP treated patients were included, divided in 440 seminoma GCC (SGCC) patients and 1449 with non-seminoma GCC (NSGCC). The median follow-up was 14 years. We evaluated the following factors for 3-year progression-free survival: age, non-pulmonary visceral metastases, pulmonary metastases, smoking status, primary site, and level of tumor markers.

Results

For SGCC, the 5-year OS was 92% and 68% for patients in the good and intermediate prognostic group; for NSGCC, the 5-year OS was 96%, 85%, and 65% for patients in the good, intermediate, and poor prognostic group, respectively. For SGCC patients, we found the following adverse prognostic factors not included in the current classification: older age (hazard ratio (HR), 1.44; 95% confidence interval (CI) 1.17–1.78 per 10 years), pulmonary metastases (HR, 2.80; 95% CI 1.35–5.82), and lactate dehydrogenase > 1.5 times the upper limit of normal (HR, 2.06; 95% CI 1.19–3.57). For NSGCC patients, we identified older age (HR, 1.45; 95% CI 1.29–1.64 per 10 years) and pulmonary metastases (HR, 2.15; 95% CI 1.61–2.87) as possible additional adverse prognostic factors.

Conclusions

Survival for all prognostic groups has increased since publication of the IGCCCG classification. Based on a nationwide cohort of patients treated with BEP, we have identified new possible prognostic factors not included in the current prognostic classification for patients with disseminated GCC. The findings should be validated in larger cohorts.

Clinical trial identification

Legal entity responsible for the study

Rigshospitalet, Copenhagen University Hospital

Funding

Danish Cancer Society Anna and Preben Simonsens Foundation

Disclosure

All authors have declared no conflicts of interest.