Factors Determining Survival of Patients with Germ Cell Tumor (Single Institutional Experience)
Keywords:Chemotherapy, Germ cell tumour, International germ cell cancer collaborative group (IGCCCG), Risk factors
Objective: To determine the 5-year overall survival of all the germ cell tumour stages and to identify prognostic factors affecting advanced and metastatic disease outcomes in our institution.
Study Design: Cross-sectional analytical study.
Place and Duration of Study: Shaukat Khanum Memorial Cancer Hospital and Research Centre, Lahore, Pakistan, from 2008 to 2013.
Methodology: We analyzed the overall survival (OS) of the whole study population and sub-analyzed metastatic disease according to the International germ cell cancer group (IGCCCG), and their overall survival was calculated. Clinical, radiological, biochemical, and histopathological evaluation was used to identify risk factors determining disease outcome.
Results: After analysing 186 male patients with germ cell tumours, 5-year overall survival for stages I, II, and III was 99%, 72%, and 62%, respectively. IGCCCG subgroup analysis showed that five-year overall survival for seminoma was slighter worse than non-seminoma. Five-year overall survival for reasonable risk and intermediate-risk seminoma was 68% and 46%, respectively. For non-seminoma, good, intermediate, and poor-risk categories carried five-year OS as 94%, 61%, and 49%, respectively. The presence of liver/brain metastasis, size of residual disease, primary mediastinal tumour, and tumor marker failure to decline post-chemotherapy were poor prognostic factors for metastatic disease.
Conclusion: While identifying stages in germ cell tumours and classifying metastatic patients according to IGCCCG, individual factors including the location of the primary tumor, brain/ liver metastasis, a failure of tumor markers to decline less than 20% after the first chemotherapy cycle and size of residual disease are considered poor prognostic signs.