Predictors of Outcome in Patients with Advanced Nonseminomatous Germ Cell Testicular Tumors

Background: Predictor factors determining complete response to treatment are still not clearly defined. Weaimed to evaluate clinicopathological features, risk factors, treatment responses, and survival analysis of patientwith advanced nonseminomatous GCTs (NSGCTs). Materials and
Methods: Between November 1999 andSeptember 2011, 140 patients with stage II and III NSGCTs were referred to our institutions and 125 patientswith complete clinical data were included in this retrospective study. Four cycles of BEP regimen were appliedas a first-line treatment. Salvage chemotherapy and/or high-dose chemotherapy (HDCT) with autologousstem cell transplantation were given in patients who progressed after BEP chemotherapy. Post-chemotherapysurgery was performed in selected patients with incomplete radiographic response and normal tumor markers.
Results: The median age was 28 years. For the good, intermediate and poor risk groups, compete responserates (CRR) were, 84.6%, 67.9% and 59.4%, respectively. Extragonadal tumors, stage 3 disease, intermediateand poor risk factors, rete testis invasion were associated with worse outcomes. There were 32 patients (25.6%)with non-CR who were treated with salvage treatment. Thirty-one patients died from GCTs and 94% of themhad stage III disease.
Conclusions: Even though response rates are high, some patients with GCTs still needsalvage treatment and cure cannot be achieved. Non-complete response to platinium-based first-line treatmentis a negative prognostic factor. Our study confirmed the need for a prognostic and predictive model and moreeffective salvage approaches.