Improved long term survival of patients with metastatic nonseminomatous testicular germ cell carcinoma in relation to prognostic classification systems during the cisplatin era

BAGKGROUND. The current study reviews chronologic changes in the long term outcome of patients with metastatic nonseminomatous testicular germ cell tu mors (NSTGCT) who were treated at a single institution during the past two decades. The 10-year survival of prognostic subgroups according to the clas sification of the International Germ Cell Consensus Classification Group (I GCCCG) and various other prognostic classifications is examined in time to evaluate whether cumulative experience has led to an improved outcome of pa tients with metastatic NSTGCT and to explore differences in outcome of prog nostic subgroups. METHODS. Two hundred ninety-nine patients with metastatic NSTGCT who were t reated with cisplatin-based polychemotherapy during the period from 1977 to 1996 were staged retrospectively according to the Royal Marsden (RM) class ification and the following prognostic classifications: IGCCCG, Indiana, Me dical Research Council (MRC), and European Organization for Research and Tr eatment of Cancer (EORTC). The numbers of patients who were treated during the periods 1977-1986 and 1987-1996 were 146 and 153, respectively. Surviva l curves were constructed using the Kaplan-Meier method, and disease specif ic 10-year survival rates of prognostic subgroups treated during the two co nsecutive 10-year periods were compared using the log rank test. RESULTS. The median follow-up of surviving patients during the periods 1977 -1986 and 1987-1996 was 14.7 years (range, 0.2-20.6 years) and 7.0 years (r ange, 0.4-11.4 years), respectively. The actuarial disease specific 10-year survival rate of patients with metastatic NSTGCT increased from 76% during the period 1977-1986 to 88% during the period 1987-1996 (relative risk [RR ], 0.51; 95% confidence interval [95% CI], 0.29-0.89; P < 0.05). The 10-yea r survival rates of patients with good, intermediate, and poor prognoses ac cording to the IGCCCG classification were 95%, 74%, and 37%, respectively, during the period 1977-1986 and 94%, 87%, and 66%, respectively, during the period 1987-1996, Patients with a poor prognosis according to the IGCCCG c lassification showed the greatest increase in 10-year survival (RR, 0.43; 9 5% CI, 0.18-1.04; P = 0.06). Analysis using the RM, Indiana, and EORTC clas sifications also showed an improved 10-year survival rate of patients with a poor prognosis who were treated during 1987-1996 compared with those who were treated during 1977-1986. CONCLUSIONS. The 10-year survival rate of patients with metastatic NSTGCT w ho were treated with cisplatin-based chemotherapy significantly increased f rom 76% during the period 1977-1986 to 88% during the period 1987-1996. Thi s improvement during the cisplatin era resulted mainly from an increase in the survival of patients with metastatic disease who had a poor prognosis. These results indicate that the management of patients with NSTGCT is still improving. <(c)> 2001 American Cancer Society.