Risk of residual cancer after complete response following first-line chemotherapy in men with metastatic non-seminomatous germ cell tumour and International Germ Cell Cancer Cooperative Group intermediate/poor prognosis: A multi-institutional retrospective cohort study. (March 2023)

• Record Type: Journal Article
• Authors: Antonelli, Luca; Ardizzone, Davide; Ravi, Praful; Bagrodia, Aditya; Mego, Michal; Daneshmand, Siamak; Nicolai, Nicola; Nazzani, Sebastiano; Giannatempo, Patrizia; Franza, Andrea; Heidenreich, Axel; Paffenholz, Pia; Saoud, Ragheed; Eggener, Scott; Ho, Matthew; Oswald, Nathaniel; Olson, Kathleen; Tryakin, Alexey; Fedyanin, Mikhail; Naoun, Natacha; Javaud, Christophe; Fizazi, Karim; King, Jennifer M.; Adra, Nabil; Douglawi, Antoin; Cary, Clint; Sweeney, Christopher; Fankhauser, Christian D.
• Is Part Of: European journal of cancer. Volume 182(2023)
• Page Start: 144
• Page End: 154
• Publication Date: 2023-03
• Subjects: Non-seminomatous germ cell tumour -- Retroperitoneal lymph node dissection -- International Germ Cell Cancer Cooperative Group -- Teratoma; Cancer -- Periodicals; Neoplasms -- Periodicals; Cancer -- Périodiques; Cancer; Tumors; Electronic journals; Periodicals; Electronic journals; 616.994
• DOI: 10.1016/j.ejca.2022.12.032
• Languages: English
• ISSNs: 0959-8049

Abstract

Abstract: Introduction: Current guidelines recommend surveillance in metastatic non-seminomatous germ cell tumour patients treated with first-line-chemotherapy and a complete clinical response (normalisation of serum tumour markers and residual masses <1 cm). However, this recommendation is based on a series including patients with good prognosis according to International Germ Cell Cancer Cooperative Group prognostic group (IGCCCG-PG). The aim of this study was to analyse the proportion of residual teratoma and survival among patients with intermediate/poor IGCCCG-PG and a complete clinical response after first-line-chemotherapy. Material & methods: This is a retrospective study of men with intermediate/poor IGCCCG-PG, who had a complete clinical response after first-line chemotherapy. Patients were either followed by surveillance or treated with post-chemotherapy retroperitoneal lymph node dissection (pcRPLND). Results: Between 2009 and 2018, 143 men with intermediate ( n = 83) or poor ( n = 60) IGCCCG-PG were treated at 11 international centres. Among 33 patients treated with pcRPLND, the specimen showed teratoma and viable cancer in 16 (48%) and 4 (12%). During a median a 7-year follow-up, 20/110 (18%) patients managed with surveillance relapsed, of whom seven (6%) had a retroperitoneal-only relapse versus 2/33 patients managed with pcRPLND relapsed. No difference was observed regarding overall survival (OS) among men treated with pcRPLND or surveillance (5-year OS, 93% and 89%, p -value = 0.35). The median time-to-recurrence among men on surveillance was 1.3 years (range: 0.3–9.1), and the most common sites of relapses included retroperitoneum (11%), chest (5%), and bones (4%). Conclusions: While most men with intermediate/poor IGCCCG-PG harbour teratoma/cancer in the retroperitoneum despite a complete response to first-line-chemotherapy, only 6% managed with surveillance relapsed in the retroperitoneum. There was no significant difference in OS between the two groups. Highlights: >95% long-term survival if intermediate/poor risk metastatic NSGCT and remission. Most men with intermediate/poor IGCCCG have residual cancer in the retroperitoneum. 6% of those men managed with surveillance relapse in the retroperitoneum only.