Abstract

Improved outcomes in testicular germ cell tumor patients treated at the referral center in Slovakia in the last decade.

Author
person Michal Chovanec Comenius University and National Cancer Institute, Bratislava, Slovakia info_outline Michal Chovanec, Katarina Rejlekova, Zuzana Sycova-Mila, Jana Obertova, Patrik Palacka, Nikola Hapakova, Valentina De Angelis, Katarina Kalavska, Daniela Svetlovska, Daniel Pindak, Jozef Mardiak, Michal Mego
Full text
Authors person Michal Chovanec Comenius University and National Cancer Institute, Bratislava, Slovakia info_outline Michal Chovanec, Katarina Rejlekova, Zuzana Sycova-Mila, Jana Obertova, Patrik Palacka, Nikola Hapakova, Valentina De Angelis, Katarina Kalavska, Daniela Svetlovska, Daniel Pindak, Jozef Mardiak, Michal Mego Organizations Comenius University and National Cancer Institute, Bratislava, Slovakia, Second Oncology Clinic, Faculty of Medicine, Comenius University; Department of Clinical Oncology, National Cancer Institute, Bratislava, Slovakia, Faculty of Medicine, Comenius University and National Cancer Institute, Bratislava, Slovakia, National Cancer Institute, Bratislava, Slovakia, 2nd Department of Oncology, National Cancer Institute, Bratislava, Slovakia, Comenius University, Bratislava, Slovakia, Translation Research Unit, Comenius University, National Cancer Institute, Bratislava, Slovakia, FNSP, Bratislava, Slovakia, Department of Clinical Oncology, National Cancer Institute, Commenius University, Bratislava, Slovakia, 2nd Department of Oncology, Faculty of Medicine, Comenius University, National Cancer Institute, Bratislava, Slovakia Abstract Disclosures Research Funding Other Background: Treatment at expert centers results in superior survival in patients with germ cell tumors (GCTs). This study evaluated outcomes in patients treated at National Cancer Institute in Slovakia before and after the year 2008 after refining the treatment strategies. Methods: Our institutional database was searched for GCT patients treated at National Cancer Institute in Slovakia between 1992 and 2016. A year of 2008 was selected for cutoff to compare changes in outcomes before and after this time-point due to refining treatment strategies such as centralization of post-chemotherapy surgery and incorporation of granulocyte-colony stimulating factor (G-CSF) for routine prophylaxis of febrile neutropenia. Kaplan-Meier product limit and log-rank test were used for statistical analysis. Results: This retrospective study included 485 patients treated for metastatic GCT. Two hundred and sixty-three patients (54%) were treated before 2008 (group 1) and 222 patients (46%) were treated after 2008, including (group 2). Progression-free survival (PFS) and overall survival (OS) was significantly improved in group 2 vs 1 (HR = 0.63, 95% CI 0.46-0.87; P = 0.0039 for PFS and HR = 0.44, 95% CI 0.30-0.65; P = 0.0003 for OS, respectively). In a subgroup analysis of International Germ Cell Cancer Collaborative Group criteria, favorable change in survival was observed in good-risk GCTs (HR = 0.40, 95% CI 0.24-0.67; P = 0.0009 for PFS, and HR = 0.20, 95% CI 0.10-0.38; P = 0.0002 for OS), but nor in intermediate or poor risk group. Conclusions: Treatment outcomes of GCTs have significantly improved in the last decade at our institution. We hypothesize that changes in treatment approach contributed to this improvement including centralization of post-chemotherapy retroperitoneal lymph-node dissections and routine use of granulocyte-colony stimulating factors that have been implemented in 2007. Referral bias for extremely poor risk patients in recent years may be an accounting factor for lack of improvement in this subgroup.