medwireNews: Among men with testicular germ cell tumors (TGCTs), those with more than one extrapulmonary metastasis – particularly brain metastases – have the poorest survival, according to an analysis of data the US SEER database.
After adjusting for race, year of diagnosis, laterality, and the presence of lymphovascular invasion, Phillip Pierorazio (Johns Hopkins University School of Medicine, Baltimore, Maryland, USA) and colleagues found that men with more than one extrapulmonary site of metastasis had the poorest survival, with a significant 4.27-fold increased risk for cancer-specific mortality versus patients with lung-only disease.
And among men with extrapulmomary metastasis at just one site, those with primary brain metastases were at the worst risk, with a 3.24-fold increased risk for cancer-specific mortality compared with men with lung-only disease. Those with liver or bone metastases also had poor prognoses, with significant 2.29- and 1.97-fold increased risks for cancer-specific death, respectively.
In line with this, the Kaplan–Meir estimated 3-year cancer-specific survival rate was 83.5% for patients with lung-only disease, and this was significantly higher than the rates for patients with metastases to the bone, liver, brain, and multiple non-pulmonary sites, at 71.3%, 64.5%, 56.6%, and 43.7%, respectively.
The data for the study came from the SEER database from 969 men with stage III TGCTs between 2010 and 2015, 84% of which were predominantly of non-seminomatous histology. Overall, 91% of the men had pulmonary metastases, with metastases to the liver in 20% and to the bone or brain in 10% each. They were followed up for a median of 21 months, with 185 (19%) men dying of testicular cancer in this time.
While TGCT involvement of extranodal sites such as the liver, bone, and brain has previously been associated with worse outcomes, the relative impact of each site on survival among patients with non-pulmonary metastatic disease has not been systematically assessed, write the researchers in Cancer.
They stress that while the pattern of cancer spread may reflect the aggressiveness of the tumor, “importantly, the lack of a clear consensus on the optimal management strategy for extranodal metastases and the frequently resistant nature of these tumor clones to conventional therapies may contribute to the decreased survival observed.”
The team concludes: “Further incorporation of organotropism into current prognostic models for metastatic TGCTs warrants attention.”
By Catherine Booth
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