Prognostic Factors in Men With Brain Metastases From Germ Cell Tumors
As reported in the Journal of Clinical Oncology, Feldman et al, of the Global Germ Cell Cancer Group, identified prognostic factors in men with brain metastases from germ cell cancer at initial diagnosis or relapse. Overall survival was better in patients with metastases at diagnosis, a greater proportion of whom received chemotherapy.
Overall Survival
The retrospective analysis included data from 523 men with brain metastases from 46 centers in 13 countries. Brain metastases were present at initial diagnosis in 228 patients (44%) and at relapse in 295 patients. Three-year overall survival was 48% in those with metastases at diagnosis vs 27% in those with metastases at relapse (P < .001).
Prognostic Factors
On multivariate analysis, factors associated with poorer overall survival among men with brain metastases at diagnosis were mediastinal primary site for patients with nonseminoma (hazard ratio [HR] = 1.66, 95% confidence interval [CI] = 0.98–2.82), presence of liver or bone metastases (HR = 2.11, 95% CI = 1.47–3.03), and presence of multiple brain metastases (HR = 1.88, 95% CI = 1.24–2.85). Among patients with brain metastases at relapse, significant factors for poorer overall survival were multiple brain metastases (HR = 2.00, 95% CI = 1.40–2.87), liver or bone metastases (HR =1.92, 95% CI = 1.29–2.84), and at least one elevated tumor marker (α-fetoprotein ≥ 100 ng/mL or human chorionic gonadotropin ≥ 5,000 U/L; HR = 2.11, 95% CI = 1.48–3.02).
Among patients with brain metastases at diagnosis, 99% received chemotherapy; neither multimodality treatment nor high-dose chemotherapy was significantly associated with improved survival on multivariate analysis. Among men with brain metastases at relapse, 54% received chemotherapy; on multivariate analysis, multimodality treatment (HR = 0.51, P < .001, vs single modality) and high-dose chemotherapy (HR = 0.41, P = .001, vs conventional dose) were associated with improved survival.
The investigators concluded: “Men with [brain metastases] from [germ cell tumors] have poor [overall survival], particularly if additional risk factors are present. High-dose chemotherapy and multimodality treatment seemed to improve survival probabilities in men with [brain metastases] at relapse.”
Jörg Beyer, MD, of the University Hospital Zurich, is the corresponding author of the Journal of Clinical Oncology article.
The content in this post has not been reviewed by the American Society of Clinical Oncology, Inc. (ASCO®) and does not necessarily reflect the ideas and opinions of ASCO®.
