Survival of patients with testicular germ-cell tumors with poor prognosis secondary to liver metastases

Abstract

14657 Background: Most patients with disseminated germ-cell tumor have an excellent prognosis with cisplatin-based combination chemotherapy, although there have been described certain subgroups with a worse prognosis. The presence of liver metastases (LM) represents an independent cause of poor prognosis. This study reviews the clinical course and treatment results of patients treated at Instituto Nacional de Cancerología de México (INCan-Mex). Methods: The records of all patients with germ-cell cancer and LM between 1992 and 2002 were reviewed. Age, primary site, metastases site, number of metastasis sites, histopathology type, serum tumor markers (STM) levels, liver functional assay, number of LM and used chemotherapy were examinated. The overall survival (OS) and disease free survival (DFS) were analized with Kaplan-Meier method and Log Rank test. Results: Of 32 reviewed patients, median age was 24 (range 18–42 y). The primary site was testis in 27 patients and retroperitoneal in 5 patients. The number of metastasis sites was > 3 en all cases. All patients had nonseminomatous component, predominating choriocarcinoma (82%) and seminoma (78%). The 60% of patients had STM of poor prognosis. 50% of the patients had abnormal liver functional assay. 25 cases (78%) had multiple LM. First line chemotherapy had complete response (CR) in 2 patients, partial response with STM negative (PRM-) in 12 cases, partial response with STM positive (PRM+) 8, and progression in 9 patients. All patients were treated with cisplatin-based chemotherapy. No prognostic factors of chemotherapy response were determined. Only 11 cases underwent to resection surgery of retroperitoneal or pulmonary residual. No patients underwent to liver surgery. Five year OS of 32 cases were 50%, 34% with DFS, between the patients with superior response to chemotherapy (RC + PRM-) the OS and DFS was better in relation with minor response or progression (p < 0.05). The cases with RC in liver (11) were 5-year OS 100% and DFS 66% (p < 0.05). Conclusions: The clinical course and results of treatment in the 32 cases of the INCan-Mex were similar to the literature. This study represents the greatest individual serie reported. These patients with poor prognosis are candidates to innovative treatment modalities. No significant financial relationships to disclose.