PURPOSE: The prognostic relevance of the rate of decline of serum alpha-fetoprotein (AFP) and human chorionic gonadotropin (HCG) during the first 3 weeks of chemotherapy for nonseminomatous germ cell tumors (NSGCT) was studied in the context of the International Germ Cell Cancer Collaborative Group (IGCCCG) classification. PATIENTS AND METHODS: Data from 653 patients prospectively recruited in clinical trials were studied. Tumor markers were obtained before chemotherapy and 3 weeks later. Decline rates were calculated using a logarithmic formula and expressed as a predicted time to normalization (TTN). A favorable TTN was defined when both AFP and HCG had a favorable decline rate, including cases with normal values. RESULTS: The median follow-up was 50 months (range, 2 to 151 months). Tumor decline rate expressed as a predicted TTN was associated with both progression-free survival (PFS; P <.0001) and overall survival (OS; P <.0001). The 4-year PFS rates were 64% and 38% in patients from the poor-prognosis group who had a favorable and an unfavorable TTN, respectively. The 4-year OS rates were 83% and 58%, respectively. This effect was independent from the initial tumor marker values, the primary tumor site, and the presence of nonpulmonary visceral metastases: tumor marker decline rate remained a strong predictor for both PFS (hazard ratio = 2.5; P =.01) and OS (hazard ratio = 4.6; P =.002) in patients from the IGCCCG poor-prognosis group in multivariate analysis. CONCLUSION: Early predicted time to tumor marker normalization is an independent prognostic factor in patients with poor-prognosis NSGCT and may be a useful tool in the therapeutic management of these patients.
PURPOSE: The prognostic relevance of the rate of decline of serum alpha-fetoprotein (AFP) and humanchorionic gonadotropin (HCG) during the first 3 weeks of chemotherapy for nonseminomatous germ cell tumors (NSGCT) was studied in the context of the International Germ Cell Cancer Collaborative Group (IGCCCG) classification. PATIENTS AND METHODS: Data from 653 patients prospectively recruited in clinical trials were studied. Tumor markers were obtained before chemotherapy and 3 weeks later. Decline rates were calculated using a logarithmic formula and expressed as a predicted time to normalization (TTN). A favorable TTN was defined when both AFP and HCG had a favorable decline rate, including cases with normal values. RESULTS: The median follow-up was 50 months (range, 2 to 151 months). Tumor decline rate expressed as a predicted TTN was associated with both progression-free survival (PFS; P <.0001) and overall survival (OS; P <.0001). The 4-year PFS rates were 64% and 38% in patients from the poor-prognosis group who had a favorable and an unfavorable TTN, respectively. The 4-year OS rates were 83% and 58%, respectively. This effect was independent from the initial tumor marker values, the primary tumor site, and the presence of nonpulmonary visceral metastases: tumor marker decline rate remained a strong predictor for both PFS (hazard ratio = 2.5; P =.01) and OS (hazard ratio = 4.6; P =.002) in patients from the IGCCCG poor-prognosis group in multivariate analysis. CONCLUSION: Early predicted time to tumor marker normalization is an independent prognostic factor in patients with poor-prognosis NSGCT and may be a useful tool in the therapeutic management of these patients.
Authors: Adriana Fonseca; Caihong Xia; Armando J Lorenzo; Mark Krailo; Thomas A Olson; Farzana Pashankar; Marcio H Malogolowkin; James F Amatruda; Deborah F Billmire; Carlos Rodriguez-Galindo; A Lindsay Frazier; Furqan Shaikh Journal: J Clin Oncol Date: 2018-12-21 Impact factor: 44.544
Authors: Anupam Batra; Scott Ernst; Kylea Potvin; Ricardo Fernandes; Nicholas Power; James Vanhie; Eric Winquist Journal: Can Urol Assoc J Date: 2019-07-23 Impact factor: 1.862
Authors: M J Titulaer; R Soffietti; J Dalmau; N E Gilhus; B Giometto; F Graus; W Grisold; J Honnorat; P A E Sillevis Smitt; R Tanasescu; C A Vedeler; R Voltz; J J G M Verschuuren Journal: Eur J Neurol Date: 2010-09-29 Impact factor: 6.089
Authors: P Sharma; T K Jain; G K Parida; S Karunanithi; C Patel; A Sharma; S Thulkar; P K Julka; C Bal; R Kumar Journal: Br J Radiol Date: 2014-06-04 Impact factor: 3.039