Originally published as JCO Early Release 10.1200/JCO.2007.15.7453 on October 20 2008

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Clinical Outcome and Predictors of Survival in Late Relapse of Germ Cell Tumor

David S. Sharp, Brett S. Carver, Scott E. Eggener, G. Varuni Kondagunta, Robert J. Motzer, George J. Bosl, Joel Sheinfeld

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

Corresponding author: Joel Sheinfeld, MD, Department of Urology, Memorial Sloan-Kettering Cancer Center, 353 E 68th St, New York, NY 10021; e-mail: sheinfej{at}mskcc.org

Purpose Late relapse (LR) of germ cell tumor (GCT) is a well recognized entity associated with poor survival. We report on our experience with LR and determine predictors of survival.

Patients and Methods From 1990 to 2004, 75 patients were managed for LR of GCT at our institution. Clinical and pathologic parameters were reviewed. Estimates of cancer-specific survival were generated using the Kaplan-Meier method, and a Cox proportional hazards model was used to assess potential predictors of outcome.

Results The median time to LR was 6.9 years (range, 2.1 to 37.7 years). Overall, 56 patients (75%) had LR in the retroperitoneum, including 25 (93%) of 27 patients initially managed without retroperitoneal lymph node dissection. The 5-year cancer-specific survival (CSS) was 60% (95% CI, 46% to 71%). Patients who underwent complete surgical resection at time of LR (n = 45) had a 5-year CSS of 79% versus 36% for patients without complete resection (n = 30; P < .0001). The 5-year CSS for chemotherapy-naive patients was significantly greater than patients with a prior history of chemotherapy as part of their initial management (5-year CSS, 93% v 49%, respectively). In multivariable analysis of pretreatment parameters available at the time of LR, the presence of symptoms (hazard ratio [HR] = 4.9) and multifocal disease (HR = 3.0) were associated with an inferior CSS.

Conclusion The data suggest that meticulous control of the retroperitoneum is critical to prevent LR in the retroperitoneum. In multivariable analysis, patients with a symptomatic presentation and those with multifocal disease have a significantly decreased survival. Survival is greatly improved if complete surgical excision of disease is attained.

published online ahead of print at www.jco.org on October 20, 2008

Supported by a National Institute of Health Research Service Award (Grant No. T32-CA82088 to D.S.S.).

Presented in part at the 42nd Annual Meeting of the American Society of Clinical Oncology, June 2-6, 2006 Atlanta, GA.

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

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