High Conditional Survival for Patients With Metastatic Testicular Germ Cell Tumors Receiving First-Line Curative Therapy
Two-year conditional overall and disease-free survival were substantially increased in patients surviving and surviving without recurrence for 2 years after first-line curative therapy for metastatic testicular germ cell tumors, according to a study reported by Ko et al in the Journal of Clinical Oncology.
Study Details
The study included 942 patients eligible for first-line therapy who were diagnosed at five tertiary cancer centers (in Calgary, Edmonton, Toronto, Melbourne, and Boston) between January 1990 and August 2012). Among all patients, median overall survival and disease-free survival had not been reached at the time of analysis. Median follow-up was 99 months in surviving patients.
Improved Conditional Survival
Two-year conditional overall survival increased from 92% at 0 months to 98% in those alive at 24 months after diagnosis. Two-year conditional disease-free survival increased from 83% at baseline to 98% at 24 months.
In an analysis by the International Germ Cell Cancer Collaborative Group (IGCCCG) risk group, 2-year conditional overall survival improved from 97% at 0 months to 99% at 24 months in the favorable-risk group, from 94% to 99% in the intermediate-risk group, and from 71% to 93% in the poor-risk group. Two-year conditional disease-free survival increased from 91% at 0 months to 95% at 1 year in the favorable-risk group, from 84% to 95% in the intermediate-risk group, and from 55% to 85% in the poor-risk group. The IGCCCG risk group at baseline was not associated with long-term conditional overall or disease-free survival among patients who survived more than 2 years after first-line therapy.
There were no significant differences in 2-year conditional overall or disease-free survival between seminoma and nonseminoma cases. In analysis by age at diagnosis, 2-year conditional overall survival was significantly better in patients aged < 40 years vs older patients from 0 to 12 months (P < .001), but no significant difference was seen by 18 months (P = .53); a similar pattern was observed for conditional disease-free survival (P = .01 at diagnosis, P = .11 at 6 months).
The investigators concluded: “Our data suggest that the concept of conditional survival applies to patients with [metastatic testicular germ cell tumors] treated with curative therapy. Patients with [metastatic testicular germ cell tumors] who survived and remained disease free more than 2 years after the diagnosis had an excellent chance of staying alive and disease free in additional subsequent years, regardless of the initial IGCCCG risk stratification.”
Daniel Y. Heng, MD, MPH, of the Tom Baker Cancer Center, University of Calgary, Canada, is the corresponding author of the Journal of Clinical Oncology article.
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