Abstract
Purpose
To evaluate the impact of age and LDH levels in patients with relapsed seminoma.
Methods
Data on the 204 seminoma from the International Prognostic Factor Study Group (IPFSG) were analyzed. All patients experienced unequivocal relapse/progression after at least three cisplatin-based chemotherapy cycles. Age and LDH at relapse were assessed in addition to previously identified prognostic factors for all germ cell tumor patients from the database (J Clin Oncol 28:4906, 2010).
Results
The impact of the IPFSG score remained highly significant in multivariate analysis. In addition, LDH ≥1.5 times the upper limit of normal (ULN) was significant in univariate (HR 1.96; CI 1.06–3.61) and multivariate analysis (HR 1.90; CI 1.00–3.62). Age, however, was not significant. Therefore, LDH was incorporated into a modified new IPFSG seminoma score by moving patients to the next unfavorable group for patients with LDH values ≥1.5 × ULN. Three prognostic groups were thus generated, which better subdivided seminoma patients than the original IPFSG score. Progression-free survival at 2 years: “very low risk” (n = 23) 85.7 % (95 % CI 62–95), “low risk” (n = 44) 62.7 % (95 % CI 46–75) and “intermediate risk” (n = 36) 35.1 % (95 % CI 20–51). Overall survival at 3 years: “very low risk” 88.8 % (95 % CI 62–97), “low risk” 71.3 % (95 % CI 55–83) and “intermediate risk” 51.3 % (95 % CI 33–67).
Conclusion
The addition of LDH, but not age, improves the impact of the IPFSG prognostic score in seminoma patients relapsing or progressing after cisplatin-based chemotherapy.
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References
Anonymous (1997) A prognostic factor based staging system for metastatic germ cell cancers. J Clin Oncol 15:594–603
Beyer J, Kramar A, Mandanas R et al (1996) High-dose chemotherapy as salvage treatment in germ cell tumors: a multivariate analysis of prognostic variables. J Clin Oncol 14:2638–2645
Einhorn LH, Williams SD, Chamness A et al (2007) High-dose chemotherapy and stemcell rescue for metastatic germ-cell tumors. N Engl J Med 357:340–348
Fossa SD, Stenning SP, Gerl A et al (1999) Prognostic factors in patients progressing after cisplatin-based chemotherapy for malignant non-seminomatous germ cell tumours. Br J Cancer 80:1392–1399
Fossa SD, Cvancarova M, Chen L, Allan AL, Oldenburg J, Peterson DR, Travis LB (2011) Adverse prognostic factors for testicular cancer-specific survival: a population-based study of 27,948 patients. J Clin Oncol 29:963–970
Gerl A, Clemm C, Schmeller N et al (1995) Prognosis after salvage treatment for unselected male patients with germ cell tumours. Br J Cancer 72:1026–1032
Gerlinger M, Wilson P, Powles T, Shamash J (2010) Elevated LDH predicts poor outcome of recurrent germ cell tumours treated with dose dense chemotherapy. Eur J Cancer 46:2913–2918
Harrell FE, Lee KL, Mark DB (1996) Tutorial in biostatistics: multivariable prognostic models: issues in developing models, evaluating assumptions and adequacy, and measuring and reducing errors. Stat Med 15:361–387
International Prognostic Factors Study Group (2010) Prognostic factors in patients with metastatic germ cell tumors who experienced treatment failure with cisplatin-based first-line chemotherapy. J Clin Oncol 28:4906–4911
Kaplan EL, Meier P (1958) Non-parametric estimation from incomplete observations. J Am Stat Assoc 53:457–481
Kramar A, Droz JP, Rey A et al (1993) Prognostic factors in non-seminomatous germ cell tumours of the testis. Experience at the Institut Gustave-Roussy. Eur Urol 23:188–195
Motzer RJ, Mazumdar M, Sheinfeld J et al (2000) Sequential dose-intensive paclitaxel, ifosfamide, carboplatin, and etoposide salvage therapy for germ cell tumor patients. J Clin Oncol 18:1173–1180
Powles TB, Bhardwa J, Shamash J, Mandalia S, Oliver T (2005) The changing presentation of germ cell tumours of the testis between 1983 and 2002. BJU Int 95:1197–1200
Rick O, Siegert W, Schwella N, Dubiel M, Krusch A, Beyer J (2002) High-dose chemotherapy as salvage treatment for seminoma. Bone Marrow Transplant 30:157160
Sammler C, Beyer J, Bokemeyer C et al (2008) Risk factors in germ cell tumour patients with relapse or progressive disease after first-line chemotherapy: evaluation of a prognostic score for survival after high-dose chemotherapy. Eur J Cancer 44:237–243
Acknowledgments
We gratefully acknowledge the contribution of the following colleagues to the database: A. Lorch, A. Neubauer, (Marburg, Germany) (n = 270); J. Beyer, O. Rick (Berlin, Germany) (n = 157); L. Einhorn (Indiana, USA) (n = 151); A. Necchi, n. Nicolai, R. Salvioni (Milan, Italy) (n = 113); K. Fizazi, C. Massard (Paris Villejuif, France) (n = 108); the Italian Germ-Cell Cancer Group (U. De Giorgi, Lecce; M. Aieta, Rionero in Vulture; A. Chioni, Grosseto; R. De Vivo, Vicenza; G. Fornarini, Genova; G. Palmieri, Naples; G.L. Banna, S. Scandurra, Catania; M. Berretta, Aviano; S. Pessa, Treviso; C. Messina, Bergamo; F. Valcamonico, Brescia; P. Pedrazzoli, I. Schiavetto, Milan; C. Ortega, R. Vormola, Candiolo; G. Lo Re, S. Tumolo, Pordenone; U. Basso, Padua; T. Sava, Verona; F. Morelli, S. Giovanni Rotondo; L. Tedeschi, Milan; M. Simonelli, P. Zucali, Milan; G. Pizzocaro, Milan; all in Italy) (n = 82); H.Boyle, J.P. Droz, A. Fléchon (Lyon, France) (n = 80); K. Margolin, (Duarte, USA) (n = 52); A. Baron, J.P. Lotz (Paris Tenon, France) (n = 51); the Spanish Germ-Cell Cancer Group (A. Fernández, Albacete; J.R. Germà, P. Maroto, B. Mellado, Barcelona; P. Martínez del Prado, Bilbao; S. Vázquez, Lugo; J.A. Arranz, D. Castellanos, J. Sastre, Madrid; J. Terrasa, Mallorca; E. González, Murcia; N. Lainez, Navarra; M. Sánchez, San Sebastián; J. Gumà, Tarragona; F.J. Dorta, Tenerife; D. Almenar, J. Aparicio, M.A. Climent, R. Gironés, Valencia; A.Saenz, Zaragoza; all in Spain) (n = 50); T. Powles, J. Shamash (London Bartholomews, UK) (n = 46); C. Kollmannsberger (Vancouver, Canada) (n = 45); J.T. Hartmann, F. Mayer (Tübingen, Germany) (n = 37); J. Kirby, B. Mead, P. Simmonds (Southampton, UK) (n = 32); C. Bokemeyer, F. Honecker, K. Oechsle (Hamburg, Germany) (n = 28); S. Fossa, J. Oldenburg (Oslo, Norway) (n = 28); S. Rodenhuis (Amsterdam, Netherlands) (n = 26); M. Fenner (Hannover, Germany) (n = 26); G. Papiani, G. Rosti (Ravenna, Italy) (n = 24); G. Bosl, D. Feldman, R. Motzer, S. Turkula (New York, USA) (n = 22); P. Savage (London Charing Cross, UK) (n = 17); T. Gauler (Essen, Germany) (n = 17); B. Hayes-Lattin, C. Moore, C. Nichols (Portland, USA) (n = 16); C. Rehmsmeier, W.E. Berdel (Muenster, Germany) (n = 16); M. DeSantis, D. Jahn-Kuch (Vienna, Austria) (n = 15); E. Cavallin-Stahl, G. Cohn-Cedermark (Stockholm, Sweden) (n = 15); O. Dahl (Bergen, Norway) (n = 15); C. Higano (Seattle, USA) (n = 14); G. Daugaard (Copenhagen, Denmark) (n = 13); M. Hentrich (Munich Harlaching, Germany) (n = 12); A. Dieing, C. Sammler (Berlin Charite, Germany) (n = 11); H. Wandt (Nürnberg, Germany) (n = 11); B. Metzner (Oldenburg, Germany) (n = 10); P. Schöffski (Leuven, Belgium) (n = 10); B. Binh, N. Houede (Bordeaux, France) (n = 9); A. Gerl (Munich, Germany) (n = 6); S. Gillessen (St. Gallen, Switzerland) (n = 2); R. Cathomas (Chur, Switzerland) (n = 2).
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All authors declare that “we have no conflict of interest” in any form regarding the data presented in this submission.
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This study was conducted for the International Prognostic Factors Study Group.
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Powles, T., Bascoul-Mollevi, C., Kramar, A. et al. Prognostic impact of LDH levels in patients with relapsed/refractory seminoma. J Cancer Res Clin Oncol 139, 1311–1316 (2013). https://doi.org/10.1007/s00432-013-1442-0
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DOI: https://doi.org/10.1007/s00432-013-1442-0