Originally published as JCO Early Release 10.1200/JCO.2007.13.6283 on November 12 2007

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Improved Clinical Outcome in Recent Years for Men With Metastatic Nonseminomatous Germ Cell Tumors

Brett S. Carver, Angel M. Serio, Dean Bajorin, Robert J. Motzer, Jason Stasi, George J. Bosl, Andrew J. Vickers, Joel Sheinfeld

From the Departments of Urology, Medicine, and Epidemiology and Biostatistics, Memorial Sloan-Kettering Cancer Center, New York, NY

Address reprint requests to Brett S. Carver, MD, Department of Urology, Sidney Kimmel Center for Prostate and Urologic Cancers, 353 E 68th St, New York, NY 10021; e-mail: carverb{at}mskcc.org

Purpose The integration of chemotherapy and surgery for metastatic nonseminomatous germ cell tumors (NSGCT) results in survival rates of greater than 80% overall. We evaluated men undergoing postchemotherapy retroperitoneal lymph node dissection (PC-RPLND) for NSGCT to determine associations between year of treatment and clinical outcome.

Patients and Methods We evaluated 504 men who underwent PC-RPLND from 1989 to 2002 for NSGCT at our center. Data were obtained from our prospective surgical database and a multivariable logistic regression model was constructed to evaluate variables associated with 15-month relapse in 392 patients with complete data.

Results From 1989 to 1997, clinical stage IIa, IIb, IIc, and III NSGCT was seen in 4%, 20%, 23%, and 47% of patients, respectively, compared with 18%, 26%, 11%, and 38%, respectively, from 1998 to 2002 (P < .001). The median prechemotherapy nodal size for 1989 to 1997 and 1998 to 2002 was 5.0 and 3.5 cm, respectively (P < .001). On multivariable analysis, prechemotherapy retroperitoneal nodal size (odds ratio [OR], 1.12; 95% CI, 1.03 to 1.21; P = .005) and presence of visceral metastasis (OR, 2.10; 95% CI, 1.02 to 4.33; P = .04) were significantly associated with 15-month relapse. Men who received a complete RPLND were significantly less likely to experience relapse (OR, 0.22; 95% CI, 0.09 to 0.50; P < .0005).

Conclusion In more recent years, men are presenting with less advanced metastatic NSGCT. This stage migration together with effective therapy has resulted in an improved relapse-free survival.

published online ahead of print at www.jco.org on November 12, 2007.

Authors' disclosures of potential conflicts of interest and author contributions are found at the end of this article.

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