Words of wisdom. Re: Conventional-dose versus high-dose chemotherapy as first salvage treatment in male patients with metastatic germ cell tumors: evidence from a large international database. Re: Prognostic factors in patients with metastatic germ cell tumors who experienced treatment failure with cisplatin-based first-line chemotherapy.

摘要

In a large retrospective and international analysis, the International Prognostic Factors Study Group, led by Anja Lorch and Jorg Beyer from the German Testicular Cancer Study Group, was able to generate a scoring system for patients with metastatic germ cell cancer who had failed first-line treatment. In nearly 2000 patients, histology of the primary tumor, location, treatment response, and progression-free interval after first-line treatment as well as levels of a-fetoprotein and human chorionic gonadotropin and presence of liver, bone, or brain metastases at the time of salvage treatment were identified as prognostic factors for the outcome after salvage treatment. The Lorch-Beyer scoring system is able to identify five prognostic groups with 2-yr survival rates ranging from 75% in the very low-risk group to only 6% in the very high-risk group. Another analysis compared patient groups that received either conventional-dose chemotherapy (CDCT) or high-dose chemotherapy (HDCT) as first salvage treatment. This analysis revealed a tremendous benefit in favor of HDCT for all but one of the prognostic groups, with hazard ratios of 0.44 (95% confidence interval [CI], 0.39-0.51) for progression-free survival and 0.65 (95% CI, 0.56-0.75) for overall survival (OS).