TY - JOUR
T1 - Site of extranodal metastasis impacts survival in patients with testicular germ cell tumors
AU - Patel, Hiten D.
AU - Singla, Nirmish
AU - Ghandour, Rashed A.
AU - Freifeld, Yuval
AU - Cheaib, Joseph G.
AU - Woldu, Solomon L.
AU - Pierorazio, Phillip M.
AU - Bagrodia, Aditya
N1 - Publisher Copyright:
© 2019 American Cancer Society
PY - 2019/11/15
Y1 - 2019/11/15
N2 - Background: Using a large, nationally representative, population-based cancer registry, this study systematically evaluated the impact of the location and burden of extranodal testicular germ cell tumor (TGCT) metastases on survival. Methods: Men with stage III TGCTs captured by the Surveillance, Epidemiology, and End Results registry from 2010 to 2015 with distant extranodal metastases were identified. Clinicopathologic information was collected, and patients were subdivided according to the specific organ site or sites of metastatic involvement (lung, liver, bone, and/or brain). Kaplan-Meier analysis and multivariable Cox regression were used to evaluate cancer-specific survival (CSS), and model performance was assessed with Harrell's C statistic. Results: Nine hundred sixty-nine patients with stage III TGCTs were included with predominantly nonseminomatous histology (84%). Most patients (91%) had pulmonary metastases, whereas 20%, 10%, and 10% had liver, bone, and brain metastases, respectively. Over a median follow-up of 21 months, 19% of these men died of TGCTs. When they were grouped by the primary site of metastasis, patients with more than 1 extrapulmonary metastasis exhibited the worst CSS (hazard ratio [HR] vs isolated pulmonary involvement, 4.27; 95% confidence interval [CI], 2.60-7.00; P <.01). Among patients with isolated extrapulmonary involvement, those with brain metastases had the poorest survival (HR, 3.24; 95% CI, 1.98-5.28; P <.01), and they were followed by patients with liver (HR, 2.29; 95% CI, 1.56-3.35; P <.01) and bone metastases (HR, 1.97; 95% CI, 1.11-3.50; P =.02). Harrell's C statistic (multivariable) was 0.71. Conclusions: The site of metastatic involvement affects survival outcomes for patients with TGCTs, and this may reflect both the aggressive biology and the challenging treatment of these tumors. Further incorporation of organotropism into current prognostic models for metastatic TGCTs warrants attention.
AB - Background: Using a large, nationally representative, population-based cancer registry, this study systematically evaluated the impact of the location and burden of extranodal testicular germ cell tumor (TGCT) metastases on survival. Methods: Men with stage III TGCTs captured by the Surveillance, Epidemiology, and End Results registry from 2010 to 2015 with distant extranodal metastases were identified. Clinicopathologic information was collected, and patients were subdivided according to the specific organ site or sites of metastatic involvement (lung, liver, bone, and/or brain). Kaplan-Meier analysis and multivariable Cox regression were used to evaluate cancer-specific survival (CSS), and model performance was assessed with Harrell's C statistic. Results: Nine hundred sixty-nine patients with stage III TGCTs were included with predominantly nonseminomatous histology (84%). Most patients (91%) had pulmonary metastases, whereas 20%, 10%, and 10% had liver, bone, and brain metastases, respectively. Over a median follow-up of 21 months, 19% of these men died of TGCTs. When they were grouped by the primary site of metastasis, patients with more than 1 extrapulmonary metastasis exhibited the worst CSS (hazard ratio [HR] vs isolated pulmonary involvement, 4.27; 95% confidence interval [CI], 2.60-7.00; P <.01). Among patients with isolated extrapulmonary involvement, those with brain metastases had the poorest survival (HR, 3.24; 95% CI, 1.98-5.28; P <.01), and they were followed by patients with liver (HR, 2.29; 95% CI, 1.56-3.35; P <.01) and bone metastases (HR, 1.97; 95% CI, 1.11-3.50; P =.02). Harrell's C statistic (multivariable) was 0.71. Conclusions: The site of metastatic involvement affects survival outcomes for patients with TGCTs, and this may reflect both the aggressive biology and the challenging treatment of these tumors. Further incorporation of organotropism into current prognostic models for metastatic TGCTs warrants attention.
KW - epidemiology
KW - metastasis
KW - organotropism
KW - outcomes
KW - testicular cancer
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U2 - 10.1002/cncr.32427
DO - 10.1002/cncr.32427
M3 - Article
C2 - 31355922
AN - SCOPUS:85074305245
SN - 0008-543X
VL - 125
SP - 3947
EP - 3952
JO - Cancer
JF - Cancer
IS - 22
ER -