Predictors of Outcome in Patients with Advanced Nonseminomatous Germ Cell Testicular Tumors

Abstract

Background: Predictor factors determining complete response to treatment are still not clearly defined. We aimed to evaluate clinicopathological features, risk factors, treatment responses, and survival analysis of patient with advanced nonseminomatous GCTs (NSGCTs). Materials and Methods: Between November 1999 and September 2011, 140 patients with stage II and III NSGCTs were referred to our institutions and 125 patients with complete clinical data were included in this retrospective study. Four cycles of BEP regimen were applied as a first-line treatment. Salvage chemotherapy and/or high-dose chemotherapy (HDCT) with autologous stem cell transplantation were given in patients who progressed after BEP chemotherapy. Post-chemotherapy surgery was performed in selected patients with incomplete radiographic response and normal tumor markers. Results: The median age was 28 years. For the good, intermediate and poor risk groups, compete response rates (CRR) were, 84.6%, 67.9% and 59.4%, respectively. Extragonadal tumors, stage 3 disease, intermediate and poor risk factors, rete testis invasion were associated with worse outcomes. There were 32 patients (25.6%) with non-CR who were treated with salvage treatment. Thirty-one patients died from GCTs and 94% of them had stage III disease. Conclusions: Even though response rates are high, some patients with GCTs still need salvage treatment and cure cannot be achieved. Non-complete response to platinium-based first-line treatment is a negative prognostic factor. Our study confirmed the need for a prognostic and predictive model and more effective salvage approaches.

MGMT and CALCA promoter methylation are associated with poor prognosis in testicular germ cell tumor patients

“…In this study, the frequency of promoter methylation of eight candidate genes ( MGMT, CALCA , VGF, HOXA9, NANOG , CDKN2B, CDO1 and ADAMTS1 ) was evaluated to assess a set of potential biomarkers that would accurately discriminate clinical outcome of patients with TGCT. A significant proportion of TGCT patients (15-25%) presents refractory disease, which results in a poor outcome [ 17 , 18 ]. Therefore, efforts to identify new molecular prognostic markers are essential in TGCT, especially for these refractory patients [ 19 ].…”

Immune Reconstitution of CD4+T Cells after Allogeneic Hematopoietic Stem Cell Transplantation and its Correlation with Invasive Fungal Infection in Patients with Hematological Malignancies

“…Allogeneic hematopoietic stem cell transplantation (Allo-HSCT) has been an effective way to treat solid tumors, hematological malignancy and immunodeficiency disease (Mohty et al, 2011;Yetisyigit et al, 2014). Hematopoietic reconstitution is possible after Allo-HSCT, and most of patients could immediately obtain granulocytes and platelet reconstitution 2~3 weeks after transplantation, but the process of immune reconstitution is delayed (Mensen et al, 2014).…”

Extragonadal yolk sac tumor (endodermal sinus tumor) presenting with biliary tract obstruction in a woman

“…Typical treatment regimens include bleomycin, etoposide, and cisplatin (BEP) for four cycles. Baseline pulmonary function tests must be obtained before using bleomycin and, if bleomycin is contraindicated due to underlying lung disease, alternate treatment regimens may include ifosfamide in place of bleomycin, with or without stem cell transplant [4,12,17] . Patients such as our patient who are resistant to initial BEP therapy have a worse prognosis [18] .…”