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Prognostic factors in metastatic nonseminomatous germ cell tumours
P R Hanson1, P Belitsky, O H Millard
1Department of Urology, Dalhousie University, Victoria General Hospital, Halifax, NS.
Objective:
To determine predictors of prognostic significance for patients with nonseminomatous testicular cancer (NSTC) who have advanced disease at the time of presentation.
Design:
A chart review with a mean patient follow-up of 5.5 years (range from 0.75 to 13 years).
Setting:
University hospitals in Halifax.
Patients:
All patients with NSTC, stages II-B, II-C and III. Patients were excluded if the follow-up status at the time the study closed could not be determined. Thirty-three patients were included in the study. Current patient status was determined from the clinical charts and personal communication with the patients or their physicians.
Interventions:
All patients received cisplatinum-based chemotherapy. The extent of the disease was assessed by chest radiography or lung tomography, bone scanning, abdominal computed tomography or lymphangiography.
Main Outcome Measures:
Correlation between levels of beta-human chorionic gonadotropin (BHCG) and alpha-fetoprotein (AFP), comparison of duration of symptoms before initial treatment, response to treatment and survival, and relationship between stage, tumour volume and survival.
Results:
The 3-year overall survival rate was 76%. Seven of 18 patients with symptoms for more than 16 weeks died of disease (p < 0.01). Overall complete response was seen in 27 of 33 patients. All initial nonresponders died. A survival rate of 93% was seen among initial complete responders (p < 0.01). All seven patients with persistent elevation of BHCG levels (p < 0.001) and the two patients with persistent elevation of AFP levels (p < 0.01) after the second course of chemotherapy died.
Conclusions:
A symptomatic interval of more than 16 weeks, poor response to initial treatment, bulky retroperitoneal disease, larger volume lung disease and persistently elevated levels of BHCG and AFP were all indicators of poor prognosis.