Jane L Meisel1, Kaitlin M Woo2, Nora Sudarsan3, Jana Eng4, Sujata Patil2, Erin P Jacobsen4, Rajmohan Murali5, Ginger J Gardner6, George J Bosl4, Carol Aghajanian1, Darren R Feldman7. 1. Gynecologic Medical Oncology Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, United States. 2. Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, NY, United States. 3. Department of Medicine, St. Luke's Roosevelt Hospital Center, Continuum Cancer Centers, New York, NY, United States. 4. Genitourinary Oncology Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, United States. 5. Department of Pathology, Memorial Sloan Kettering Cancer Center, New York, NY, United States; Marie-Josée and Henry R. Kravis Center for Molecular Oncology, Memorial Sloan Kettering Cancer Center, New York, NY, United States. 6. Gynecology Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, United States. 7. Genitourinary Oncology Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, United States. Electronic address: feldmand@mskcc.org.
Abstract
OBJECTIVE: Due to their rarity, little is known about prognostic factors in female germ cell tumors (GCTs) or outcomes following systemic therapy. Management is largely based on studies of male GCT and epithelial ovarian cancer. METHODS: Chart review was performed for all females with GCT seen at Memorial Sloan Kettering Cancer Center (MSKCC) from 1990 to 2012. Patients receiving chemotherapy were stratified using a modification of the male IGCCCG risk system, and the classifier was correlated with outcome. RESULTS: Of 93 patients, 92 (99%) underwent primary surgery and 85 (92%) received chemotherapy. Modified IGCCCG classification was significantly associated with progression-free survival (PFS) and overall survival (OS), both when applied preoperatively and pre-chemotherapy (p<0.001 for all four analyses). Progression after initial chemotherapy (n=29) was detected by imaging in 14 (48%) patients, by serum tumor markers in 6 (21%) patients, and by multiple methods in the rest. Seven (29%) of 24 patients treated with salvage chemotherapy achieved long-term PFS, including 4/6 who received high-dose chemotherapy (HDCT) as initial salvage versus 3/16 treated with other initial salvage regimens. The estimated 3-year OS rate was 84% (95% CI, 76-92%), with a trend favoring dysgerminoma over non-dysgerminoma histologies (p=0.12). CONCLUSIONS: Modified IGCCCG classification was prognostic for female GCT patients in this cohort and identified a poor-risk group who may benefit from more intensive first-line chemotherapy. Both imaging and tumor marker evaluation were important in identifying relapses after first-line chemotherapy. The majority of long-term remissions with salvage therapy were achieved with initial salvage HDCT.
OBJECTIVE: Due to their rarity, little is known about prognostic factors in female germ cell tumors (GCTs) or outcomes following systemic therapy. Management is largely based on studies of male GCT and epithelial ovarian cancer. METHODS: Chart review was performed for all females with GCT seen at Memorial Sloan Kettering Cancer Center (MSKCC) from 1990 to 2012. Patients receiving chemotherapy were stratified using a modification of the male IGCCCG risk system, and the classifier was correlated with outcome. RESULTS: Of 93 patients, 92 (99%) underwent primary surgery and 85 (92%) received chemotherapy. Modified IGCCCG classification was significantly associated with progression-free survival (PFS) and overall survival (OS), both when applied preoperatively and pre-chemotherapy (p<0.001 for all four analyses). Progression after initial chemotherapy (n=29) was detected by imaging in 14 (48%) patients, by serum tumor markers in 6 (21%) patients, and by multiple methods in the rest. Seven (29%) of 24 patients treated with salvage chemotherapy achieved long-term PFS, including 4/6 who received high-dose chemotherapy (HDCT) as initial salvage versus 3/16 treated with other initial salvage regimens. The estimated 3-year OS rate was 84% (95% CI, 76-92%), with a trend favoring dysgerminoma over non-dysgerminoma histologies (p=0.12). CONCLUSIONS: Modified IGCCCG classification was prognostic for female GCTpatients in this cohort and identified a poor-risk group who may benefit from more intensive first-line chemotherapy. Both imaging and tumor marker evaluation were important in identifying relapses after first-line chemotherapy. The majority of long-term remissions with salvage therapy were achieved with initial salvage HDCT.
Authors: O Solheim; D M Gershenson; C G Tropé; E Rokkones; C C Sun; H Weedon-Fekjaer; S D Fosså Journal: Eur J Cancer Date: 2014-05-20 Impact factor: 9.162
Authors: E P Fox; T D Weathers; S D Williams; P J Loehrer; T M Ulbright; J P Donohue; L H Einhorn Journal: J Clin Oncol Date: 1993-07 Impact factor: 44.544
Authors: Chung Won Lee; Min Jong Song; Sung Taek Park; Eun Young Ki; Sung Jong Lee; Keun Ho Lee; Ki Sung Ryu; Jong Sup Park; Soo Young Hur Journal: World J Surg Oncol Date: 2011-10-11 Impact factor: 2.754
Authors: Z DeFilipp; C B Rosand; D A Goldstein; V A Master; B C Carthon; W B Harris; O Kucuk; Z Al-Kadhimi; J B Cohen; C R Flowers; M J Lechowicz; A K Nooka; J L Kaufman; A A Langston; Z Chen; J Arora; E K Waller Journal: Bone Marrow Transplant Date: 2016-07-18 Impact factor: 5.483
Authors: Nicola J Lawrence; Howard Chan; Guy Toner; Martin R Stockler; Andrew Martin; Sonia Yip; Nicole Wong; Annie Yeung; Danish Mazhar; Farzana Pashankar; Lindsay Frazier; Ray McDermott; Roderick Walker; Hsiang Tan; Ian D Davis; Peter Grimison Journal: BMC Cancer Date: 2018-08-29 Impact factor: 4.430
Authors: C Newton; K Murali; A Ahmad; H Hockings; R Graham; V Liberale; S-J Sarker; J Ledermann; D M Berney; J Shamash; S Banerjee; S Stoneham; M Lockley Journal: Eur J Cancer Date: 2019-04-04 Impact factor: 9.162