Influence of Prognostic Group Classification of Advanced Male Germ Cell Tumor on Treatment Outcomes

Abstract

Background: Male germ cell tumor is a rare disease, associated with high rates of cure, including in the advanced setting. This disease mostly affects young males aged 15-34 years. The rising incidence trends of germ cell tumors in the last two decades have defined a new priority area of oncology. Objective: To investigate the influence of prognostic group classification and histology on treatment outcomes in men treated in a single institution in Pakistan. Methods: We developed an observational study on fifty male patients diagnosed with advanced germ cell cancer completing first-line treatment, between 2011-2014. Patients with a follow-up time of at least 5 years post-treatment were included. Patients were classified into good, intermediate, and poor prognostic groups, according to the International Germ Cell Cancer Collaborative Group classification (IGCCCG). The outcomes of all three prognostic groups were measured including response to first-line treatment according to Memorial Sloan-Kettering Cancer Center criteria and five years OS. Survival rates were calculated using Kaplan and Meier method. The level of significance was set at P < 0.05. Results: Overall 50 patients were included in the study. The mean age of patients was 30.6 years + 9.49 years. The most common primary site of involvement was the right testicle i.e.56.0%. Complete responses (CR) were observed in 23 (46.0%) patients. The patients classified into the good prognostic group (n=29) had significantly superior (p=0.002) five years OS (86.2%, n= 25) than intermediate and poor groups. Additionally, CR was higher for seminoma-type cancer i.e. 12 (63.15%) while it was limited to 11(35.48%) in non-seminoma; however, the inferior response rate in NSGCT did not translate into statistical significance in 5 years OS. Conclusion: The IGCCCG prognostic grouping system is an effective tool for predicting treatment outcomes in terms of 5-year overall survival in our local population based in a low-middle income setting.