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Topal A, Erturk I, Koseoglu C, Dumludag A, Kuzu ÖF, Durmaz P, Akdag G, Keskin GSY, Karadurmus N. The Role of High Dose Chemotherapy with Autologous Hematopoietic Cell Transplant in Relapsed/Refractory Ovarian Germ Cell Tumors: A Single Center Experience. Clin Genitourin Cancer 2024; 22:102106. [PMID: 38852437 DOI: 10.1016/j.clgc.2024.102106] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2024] [Revised: 04/21/2024] [Accepted: 04/25/2024] [Indexed: 06/11/2024]
Abstract
OBJECTIVE We aimed to investigate response rates, survival analyses and factors affecting survival in patients with relapsed or refractory ovarian germ cell tumours who had previously received multiple lines of treatment, including high-dose chemotherapy (HDC) and autologous stem cell transplantation (ASCT). METHODS This study was designed as a cross-sectional, retrospective study. RESULTS Twenty-one patients were included. After HDC + ASCT, complete response (CR) was observed in 11 patients (52.3%), partial response (PR) in 3 patients (14.3%), stable disease (SD) in 3 patients (14.3%) and progressive disease (PD) in 4 patients (19.1%). TRM was observed in 1 patient. Median follow-up was 51.7 months. Median PFS and OS after HDC + ASCT were calculated to be 6.0 months and 14.8 months, respectively. CONCLUSIONS Salvage HDC + ASCT is an effective option in the treatment of relapsed/refractory ovarian germ cell tumours, offering the potential for prolonged survival and cure.
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Affiliation(s)
- Alper Topal
- Gulhane Research & Training Hospital, Department of Internal Medicine, Division of Medical Oncology, Ankara, Türkiye.
| | - Ismail Erturk
- Gulhane Research & Training Hospital, Department of Internal Medicine, Division of Medical Oncology, Ankara, Türkiye
| | - Caglar Koseoglu
- Gulhane Research & Training Hospital, Department of Internal Medicine, Division of Medical Oncology, Ankara, Türkiye
| | - Aysegul Dumludag
- Gulhane Research & Training Hospital, Department of Internal Medicine, Division of Medical Oncology, Ankara, Türkiye
| | - Ömer Faruk Kuzu
- Gulhane Research & Training Hospital, Department of Internal Medicine, Division of Medical Oncology, Ankara, Türkiye
| | - Pelin Durmaz
- Gulhane Research & Training Hospital, Department of Internal Medicine, Division of Medical Oncology, Ankara, Türkiye
| | - Goncagul Akdag
- Department of Medical Oncology, Kartal Dr. Lütfi Kirdar City Hospital, Health Science University, Istanbul, Turkey
| | - Gul Sema Yildiran Keskin
- Gulhane Research & Training Hospital, Department of Internal Medicine, Division of Medical Oncology, Ankara, Türkiye
| | - Nuri Karadurmus
- Gulhane Research & Training Hospital, Department of Internal Medicine, Division of Medical Oncology, Ankara, Türkiye
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Li S, Zhang R, Zhang X, Zhang T, Cao D, Xiang Y, Yang J. Component Patterns and Survival Outcomes in Patients with Mixed Malignant Ovarian Germ Cell Tumors: A Retrospective Cohort Study. Clin Oncol (R Coll Radiol) 2024; 36:370-377. [PMID: 38555208 DOI: 10.1016/j.clon.2024.03.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2023] [Revised: 01/02/2024] [Accepted: 03/11/2024] [Indexed: 04/02/2024]
Abstract
AIMS To evaluate the component patterns and risk stratification in patients with mixed malignant ovarian germ cell tumors (mMOGCT). METHODS A retrospective study of 70 mMOGCT patients treated in our hospital between 2000 and 2022 was conducted. The recurrence-free survival (RFS), disease-specific survival (DSS), and risk stratification systems based on scoring the identified prognostic factors were assessed. RESULTS Yolk sac tumor component was the most common type (80%), followed by dysgerminoma (50%), immature teratoma (40%), embryonic carcinoma (27.1%), and chorionic carcinoma (15.7%). The 5-year RFS and DSS rates were 77.9% and 87.9%, respectively. International federation of gynecology and obstetrics (FIGO) stage III-IV (RR 3.253, P = 0.029) and normalization of tumor marker (TM) ≤ 3 cycles of chemotherapy (RR 6.249, P = 0.017) were risk factors for RFS and DSS, respectively. Significant DSS (RR 8.268, P = 0.006) was also noted between patients who had normalized TM ≤ 4 and ≥5 cycles of chemotherapy. FIGO stages I-II and stages III-IV were scored as 0 and 2, respectively. AFP normalization ≤3, 4, and ≥5 cycles of chemotherapy were scored as 0, 1, and 4, respectively. A total score of 0, 1-2, and ≥3 stratified patients into low-risk (43 patients), intermediate-risk (13 patients), and high-risk groups (14 patients), respectively. Patients in three risk stratifications manifested significant differences in DSS (P = 0.010) but not in RFS (P > 0.05). CONCLUSION Distinct different component patterns existed among mMOGCT patients, and predicting survival outcomes in a universal model was challenging.
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Affiliation(s)
- S Li
- National Clinical Research Center for Obstetric and Gynecologic Diseases, Department of Obstetrics and Gynecology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Peking Union Medical College, Beijing, People's Republic of China
| | - R Zhang
- National Clinical Research Center for Obstetric and Gynecologic Diseases, Department of Obstetrics and Gynecology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Peking Union Medical College, Beijing, People's Republic of China
| | - X Zhang
- National Clinical Research Center for Obstetric and Gynecologic Diseases, Department of Obstetrics and Gynecology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Peking Union Medical College, Beijing, People's Republic of China
| | - T Zhang
- National Clinical Research Center for Obstetric and Gynecologic Diseases, Department of Obstetrics and Gynecology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Peking Union Medical College, Beijing, People's Republic of China
| | - D Cao
- National Clinical Research Center for Obstetric and Gynecologic Diseases, Department of Obstetrics and Gynecology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Peking Union Medical College, Beijing, People's Republic of China
| | - Y Xiang
- National Clinical Research Center for Obstetric and Gynecologic Diseases, Department of Obstetrics and Gynecology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Peking Union Medical College, Beijing, People's Republic of China
| | - J Yang
- National Clinical Research Center for Obstetric and Gynecologic Diseases, Department of Obstetrics and Gynecology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Peking Union Medical College, Beijing, People's Republic of China.
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Rich BS, Dicken BJ, Billmire DF, Weil BR, Ross J, Fallahazad N, Krailo M, Shaikh F, Frazier AL, Hazard FK, Nuño MM. Characterizing Lymphovascular Invasion in Pediatric and Adolescent Malignant Ovarian Nongerminomatous Germ Cell Tumors: A Report from the Children's Oncology Group. J Pediatr Surg 2023; 58:2399-2404. [PMID: 37699777 PMCID: PMC10872999 DOI: 10.1016/j.jpedsurg.2023.08.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/19/2023] [Revised: 08/11/2023] [Accepted: 08/15/2023] [Indexed: 09/14/2023]
Abstract
BACKGROUND Lymphovascular invasion (LVI) has been identified as a poor prognostic factor for a variety of tumors; however, its significance in malignant ovarian germ cell tumors (MOGCT) in pediatric and adolescent patients is not well described. We aim to clarify the significance of LVI in the subset of patients with nongerminomatous MOGCT. METHODS Records of patients 0-20 years of age with MOGCT enrolled on Children's Oncology Group study AGCT0132 were reviewed. Patients with documented presence or absence of LVI in either institutional or central review pathology reports were included. RESULTS Of 130 patients with MOGCTs, 83 patients had of the presence or absence of LVI documented in their pathology report. 42/83 patients (50.6%) were found to have LVI present. The estimated odds of having LVI was higher in patients with stage II and III disease, 11 years and older and with the presence of choriocarcinoma. Event-free survival (EFS) and overall survival (OS) remained high in patients with LVI. Approximately 50% of patients with a documented LVI status in either institutional pathology report or central review were found to have LVI. CONCLUSIONS The presence of LVI was higher in tumors with adverse risk factors including higher stage and age greater than 11 years. While LVI was not associated with EFS or OS in the intermediate risk group, further work is necessary to determine the effect of LVI on long-term disease-free survival. We, therefore, recommend routinely incorporating LVI status into institutional pathology reports for pediatric and adolescent patients with MOGCT. LEVEL OF EVIDENCE III.
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Affiliation(s)
- Barrie S Rich
- Division of Pediatric Surgery, Cohen Children's Medical Center, Zucker School of Medicine at Hofstra/Northwell, New Hyde Park, NY, USA.
| | - Bryan J Dicken
- Division of Pediatric Surgery, University of Alberta, Edmonton Canada
| | - Deborah F Billmire
- Division of Pediatric Surgery, Riley Hospital for Children, Indiana University School of Medicine, Indianapolis, IN, USA
| | - Brent R Weil
- Division of Pediatric Surgery, Boston Children's Hospital, Harvard Medical School, Boston, MA, USA
| | - Jonathan Ross
- Department of Urology, Department of Pediatrics, Rush Medical College, Chicago, IL, USA
| | - Negar Fallahazad
- Children's Oncology Group, Public Health Institute, Monrovia, CA, USA
| | - Mark Krailo
- Children's Oncology Group, Public Health Institute, Monrovia, CA, USA; Department of Population and Public Health Sciences, University of Southern California, Los Angeles, CA, USA
| | - Furqan Shaikh
- Division of Haematology/Oncology, The Hospital for Sick Children, University of Toronto, Toronto, Canada
| | - A Lindsay Frazier
- Dana-Farber/Boston Children's Cancer and Blood Disorders Center Harvard Medical School, Boston, MA, USA
| | - Florette K Hazard
- Department of Pathology, Stanford University School of Medicine, Stanford, CA, USA
| | - Michelle M Nuño
- Children's Oncology Group, Public Health Institute, Monrovia, CA, USA; Department of Population and Public Health Sciences, University of Southern California, Los Angeles, CA, USA
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Li S, Zhang X, Zhang T, Yin M, Cao D, Xiang Y, Yang J. Prognostic factors for pure ovarian immature teratoma and the role of adjuvant chemotherapy in stage I diseases. Ann Med 2023; 55:2273984. [PMID: 37909181 PMCID: PMC10836279 DOI: 10.1080/07853890.2023.2273984] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/28/2023] [Accepted: 10/18/2023] [Indexed: 11/02/2023] Open
Abstract
BACKGROUND The prognostic factors for patients with pure ovarian immature teratoma (POIT) and the role of adjuvant chemotherapy in stage IA G2-G3 and IB-IC POIT remains controversial. METHODS We conducted a retrospective study of 155 POIT patients treated in our hospital between 2000 and 2022. The recurrence-free survival (RFS), disease-specific survival (DSS), and potential prognostic factors of POIT patients were evaluated. Subgroup analysis was conducted in stage I other than stage IA G1 POIT. RESULTS The median age at diagnosis was 23.0 years (range: 4.0 - 39.0), and 126 (81.3%), 2 (1.3%), 26 (16.8%), and 1 (0.6%) patients had FIGO stage I, stage II, stage III, and stage IV disease, respectively. Twenty-three patients relapsed and five died of the diseases after a median follow-up of 7.6 years, with a 5-year RFS and DSS rate of 86.0% and 97.0%, respectively. Multivariate analysis showed that positive postoperative tumour markers (TM) were the risk factor for recurrence in the overall cohort (hazard ratio [HR] 4.058, 95% CI 1.175 - 14.019, p = 0.027) and subgroup (HR 10.237, 95% CI 2.175 - 48.179, p = 0.003), and FIGO stage II-IV was the only factor for DSS in overall cohort (HR 7.751, 95% CI 1.281 - 46.895, p = 0.026). In 110 patients subjected to subgroup analysis, 29 patients received surveillance without chemotherapy and 81 patients were administered adjuvant chemotherapy. Multivariate analysis revealed active surveillance significantly increased the recurrence rate (5-year RFS of 75.7% vs. 93.6%, HR 7.562, 95% CI 2.441 - 23.424, p < 0.001) but not the death related to POIT (p = 0.338). CONCLUSION Positive postoperative TM and FIGO stage II-IV were the prognostic factors for POIT. Active surveillance in stage I POIT of any grade may be practical for those with negative postoperative TM.
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Affiliation(s)
- Sijian Li
- National Clinical Research Center for Obstetric and Gynecologic Diseases, Department of Obstetrics and Gynecology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Peking Union Medical College, Beijing, People’s Republic of China
| | - Xinyue Zhang
- National Clinical Research Center for Obstetric and Gynecologic Diseases, Department of Obstetrics and Gynecology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Peking Union Medical College, Beijing, People’s Republic of China
| | - Tianyu Zhang
- National Clinical Research Center for Obstetric and Gynecologic Diseases, Department of Obstetrics and Gynecology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Peking Union Medical College, Beijing, People’s Republic of China
| | - Min Yin
- National Clinical Research Center for Obstetric and Gynecologic Diseases, Department of Obstetrics and Gynecology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Peking Union Medical College, Beijing, People’s Republic of China
- Department of Gynecology, Qilu Hospital (Qingdao), Cheeloo College of Medicine, Shandong University, Qingdao, People’s Republic of China
| | - Dongyan Cao
- National Clinical Research Center for Obstetric and Gynecologic Diseases, Department of Obstetrics and Gynecology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Peking Union Medical College, Beijing, People’s Republic of China
| | - Yang Xiang
- National Clinical Research Center for Obstetric and Gynecologic Diseases, Department of Obstetrics and Gynecology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Peking Union Medical College, Beijing, People’s Republic of China
| | - Jiaxin Yang
- National Clinical Research Center for Obstetric and Gynecologic Diseases, Department of Obstetrics and Gynecology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Peking Union Medical College, Beijing, People’s Republic of China
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Li S, Zhang X, Zhang T, Zhang R, Cao D, Xiang Y, Yang J. Survival outcomes and establishment of a novel risk stratification system in patients with ovarian yolk sac tumors. Gynecol Oncol 2023; 178:145-152. [PMID: 37865050 DOI: 10.1016/j.ygyno.2023.10.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2023] [Revised: 09/30/2023] [Accepted: 10/13/2023] [Indexed: 10/23/2023]
Abstract
OBJECTIVE To evaluate the survival outcomes and establish a risk stratification system in patients with ovarian yolk sac tumors (OYST). METHODS The recurrence-free survival (RFS), disease-specific survival (DSS), and prognostic factors were retrospectively evaluated in 151 OYST patients treated in our hospital between 2006 and 2022. A risk stratification system based on the identified prognostic factors was established. RESULTS The median follow-up time was 5.1 years, with a 5-year RFS and DSS rate of 75.5% and 91.2%, respectively. FIGO stage III-IV and the interval between treatment and normalization of AFP were two prognostic predictors. Significant differences in RFS and DSS (both P < 0.001) were identified between patients who had normalized AFP ≤ 3 and ≥ 4 cycles of chemotherapy, or among patients who had normalized AFP after ≤2, 3-4, and ≥ 5 cycles of chemotherapy. FIGO stage I - II and stage III-IV were scored as 0 and 2, respectively. AFP normalization ≤2, 3, 4, and ≥ 5 cycles of chemotherapy were scored as 0, 1, 2, and 4, respectively. A total score of 0-1, 2-3, and ≥ 4 were stratified patients into low-risk (96 patients), intermediate-risk (35 patients), and high-risk groups (20 patients), respectively. Patients in three risk stratifications manifested significant differences in both RFS and DSS (P < 0.0001). CONCLUSION This risk stratification system based on tumor stage and the interval between treatment and normalization of AFP may help to guide clinical management by dividing OYST patients into three risk groups.
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Affiliation(s)
- Sijian Li
- National Clinical Research Center for Obstetric and Gynecologic Diseases, Department of Obstetrics and Gynecology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Peking Union Medical College, Beijing, People's Republic of China
| | - Xinyue Zhang
- National Clinical Research Center for Obstetric and Gynecologic Diseases, Department of Obstetrics and Gynecology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Peking Union Medical College, Beijing, People's Republic of China
| | - Tianyu Zhang
- National Clinical Research Center for Obstetric and Gynecologic Diseases, Department of Obstetrics and Gynecology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Peking Union Medical College, Beijing, People's Republic of China
| | - Rundong Zhang
- National Clinical Research Center for Obstetric and Gynecologic Diseases, Department of Obstetrics and Gynecology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Peking Union Medical College, Beijing, People's Republic of China
| | - Dongyan Cao
- National Clinical Research Center for Obstetric and Gynecologic Diseases, Department of Obstetrics and Gynecology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Peking Union Medical College, Beijing, People's Republic of China
| | - Yang Xiang
- National Clinical Research Center for Obstetric and Gynecologic Diseases, Department of Obstetrics and Gynecology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Peking Union Medical College, Beijing, People's Republic of China
| | - Jiaxin Yang
- National Clinical Research Center for Obstetric and Gynecologic Diseases, Department of Obstetrics and Gynecology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Peking Union Medical College, Beijing, People's Republic of China.
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Pinto MT, Eiras Martins G, Vieira AGS, Galvão JMS, de Pádua Souza C, Macedo CRPD, Lopes LF. Molecular Biology of Pediatric and Adult Ovarian Germ Cell Tumors: A Review. Cancers (Basel) 2023; 15:cancers15112990. [PMID: 37296950 DOI: 10.3390/cancers15112990] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2023] [Revised: 03/14/2023] [Accepted: 03/20/2023] [Indexed: 06/12/2023] Open
Abstract
Ovarian germ cell tumors (OGCTs) are rare in adults; indeed, they occur predominantly in children, adolescents, and young adults, and they account for approximately 11% of cancer diagnoses in these groups. Because OGCTs are rare tumors, our current understanding of them is sparse; this is because few studies have investigated the molecular basis of pediatric and adult cancers. Here, we review the etiopathogenesis of OGCTs in children and adults, and we address the molecular landscape of these tumors, including integrated genomic analysis, microRNAs, DNA methylation, the molecular implications of treatment resistance, and the development of in vitro and in vivo models. An elucidation of potential molecular alterations may provide a novel field for understanding the pathogenesis, tumorigenesis, diagnostic markers, and genetic peculiarity of the rarity and complexity of OGCTs.
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Affiliation(s)
| | - Gisele Eiras Martins
- Brazilian Childhood Germ Cell Tumor Study Group, The Brazilian Pediatric Oncology Society (SOBOPE), Barretos 14784400, Brazil
- Children's Cancer Hospital from Hospital de Amor, Barretos 14784400, Brazil
| | - Ana Glenda Santarosa Vieira
- Brazilian Childhood Germ Cell Tumor Study Group, The Brazilian Pediatric Oncology Society (SOBOPE), Barretos 14784400, Brazil
- Children's Cancer Hospital from Hospital de Amor, Barretos 14784400, Brazil
| | | | | | - Carla Renata Pacheco Donato Macedo
- Brazilian Childhood Germ Cell Tumor Study Group, The Brazilian Pediatric Oncology Society (SOBOPE), Barretos 14784400, Brazil
- Pediatric Oncology Department, IOP/GRAACC/Federal University of Sao Paulo, Sao Paulo 04038001, Brazil
| | - Luiz Fernando Lopes
- Brazilian Childhood Germ Cell Tumor Study Group, The Brazilian Pediatric Oncology Society (SOBOPE), Barretos 14784400, Brazil
- Children's Cancer Hospital from Hospital de Amor, Barretos 14784400, Brazil
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Liu YL, Manning-Geist BL, Knezevic A, Deng L, Bromberg M, Funt SA, Meisel JL, Zivanovic O, Roche KL, Sonoda Y, Gardner GJ, Grisham RN, O'Cearbhaill RE, Tew WP, Abu-Rustum NR, Chi DS, Aghajanian C, Feldman DR. Predicting outcomes in female germ cell tumors using a modified International Germ Cell Cancer Collaborative Group classification system to guide management. Gynecol Oncol 2023; 170:93-101. [PMID: 36669327 PMCID: PMC10023473 DOI: 10.1016/j.ygyno.2022.12.022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2022] [Revised: 12/19/2022] [Accepted: 12/29/2022] [Indexed: 01/19/2023]
Abstract
OBJECTIVE We previously developed preoperative and pre-chemotherapy modified versions of the male International Germ Cell Cancer Collaborative Group (IGCCCG) prognostic model and assessed it in female patients with germ cell tumors (GCTs). We sought to validate these modified IGCCCG (mIGCCCG) models in a new cohort. METHODS We queried institutional databases for female patients with GCTs treated at Memorial Sloan Kettering Cancer Center from 1/1/1990-6/1/2020. The mIGCCCG model classifies patients with non-dysgerminomas as good, intermediate, or poor risk based on tumor markers using male IGCCCG cutoffs and absence/presence of non-pulmonary/peritoneal visceral metastasis. In dysgerminomas, good- and intermediate-risk groups are defined by absence/presence of non-pulmonary/peritoneal visceral metastasis. Progression-free survival (PFS) and overall survival (OS) were estimated for each group in the validation and combined original and validation cohorts. Associations between individual clinical factors and outcomes were evaluated. RESULTS Among 183 female patients with GCTs, clinical characteristics and outcomes were similar between the original (n = 93) and validation (n = 90) cohorts. In multivariable models, higher stage, older age, and non-dysgerminoma histology predicted worse PFS and OS (p < 0.05). Among 162 patients who received chemotherapy, preoperative and pre-chemotherapy mIGCCCG models were significantly associated with PFS and OS (p < 0.001 for all groups). With the preoperative model, 3-year PFS rates were 94%, 76%, and 50% in the good-, intermediate-, and poor-risk patients, respectively; OS rates were 96%, 86%, and 52%, respectively. Even within stage groups, mIGCCCG risk classifications were associated with clinical outcomes. CONCLUSIONS A female-specific mIGCCCG risk model effectively stratifies patients and should be incorporated into clinical trials.
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Affiliation(s)
- Ying L Liu
- Department of Medicine, Memorial Sloan Kettering Cancer, New York, NY, USA; Department of Medicine, Weill Cornell Medical College, New York, NY, USA.
| | - Beryl L Manning-Geist
- Gynecology Service, Department of Surgery, Memorial Sloan Kettering Cancer, New York, NY, USA
| | - Andrea Knezevic
- Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer, New York, NY, USA
| | - Luxue Deng
- Atlantic Health Systems, Morristown, NJ, USA
| | - Maria Bromberg
- Department of Medicine, Memorial Sloan Kettering Cancer, New York, NY, USA
| | - Samuel A Funt
- Department of Medicine, Memorial Sloan Kettering Cancer, New York, NY, USA; Department of Medicine, Weill Cornell Medical College, New York, NY, USA
| | - Jane L Meisel
- Department of Medicine, Winship Cancer Institute, Emory, Atlanta, GA, USA
| | - Oliver Zivanovic
- Gynecology Service, Department of Surgery, Memorial Sloan Kettering Cancer, New York, NY, USA; Department of Obstetrics and Gynecology, Weill Cornell Medical College, New York, NY, USA
| | - Kara Long Roche
- Gynecology Service, Department of Surgery, Memorial Sloan Kettering Cancer, New York, NY, USA; Department of Obstetrics and Gynecology, Weill Cornell Medical College, New York, NY, USA
| | - Yukio Sonoda
- Gynecology Service, Department of Surgery, Memorial Sloan Kettering Cancer, New York, NY, USA; Department of Obstetrics and Gynecology, Weill Cornell Medical College, New York, NY, USA
| | - Ginger J Gardner
- Gynecology Service, Department of Surgery, Memorial Sloan Kettering Cancer, New York, NY, USA; Department of Obstetrics and Gynecology, Weill Cornell Medical College, New York, NY, USA
| | - Rachel N Grisham
- Department of Medicine, Memorial Sloan Kettering Cancer, New York, NY, USA; Department of Medicine, Weill Cornell Medical College, New York, NY, USA
| | - Roisin E O'Cearbhaill
- Department of Medicine, Memorial Sloan Kettering Cancer, New York, NY, USA; Department of Medicine, Weill Cornell Medical College, New York, NY, USA
| | - William P Tew
- Department of Medicine, Memorial Sloan Kettering Cancer, New York, NY, USA; Department of Medicine, Weill Cornell Medical College, New York, NY, USA
| | - Nadeem R Abu-Rustum
- Gynecology Service, Department of Surgery, Memorial Sloan Kettering Cancer, New York, NY, USA; Department of Obstetrics and Gynecology, Weill Cornell Medical College, New York, NY, USA
| | - Dennis S Chi
- Gynecology Service, Department of Surgery, Memorial Sloan Kettering Cancer, New York, NY, USA; Department of Obstetrics and Gynecology, Weill Cornell Medical College, New York, NY, USA
| | - Carol Aghajanian
- Department of Medicine, Memorial Sloan Kettering Cancer, New York, NY, USA; Department of Medicine, Weill Cornell Medical College, New York, NY, USA
| | - Darren R Feldman
- Department of Medicine, Memorial Sloan Kettering Cancer, New York, NY, USA; Department of Medicine, Weill Cornell Medical College, New York, NY, USA
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8
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Minig L, Gracia Segovia M, Arencibia O, Zorrero C, Marti L, García Pineda V, Cespedes J, Niguez I, Gil-Ibanez B, Diaz-Feijoo B, Fidalgo S, Valencia I, Alonso-Gutierrez T, Gonzalez L, Veiga-Fernandez A, Chacon E, Negredo I, Azcona Sutil L, Gorostidi M, Zapardiel I. Oncological outcomes among young women with non-epithelial ovarian cancer: the YOC-Care study (Young Ovarian Cancer - Care). Int J Gynecol Cancer 2023:ijgc-2022-004162. [PMID: 36796862 DOI: 10.1136/ijgc-2022-004162] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/18/2023] Open
Abstract
OBJECTIVE To determine oncological outcomes and associated prognostic factors in women younger than 45 years diagnosed with non-epithelial ovarian cancer. METHODS A retrospective, multicenter Spanish study was performed including women with non-epithelial ovarian cancer younger than 45 years between January 2010 and December 2019. All types of treatments and stages at diagnosis with at least 12 months of follow-up were collected. Women with missing data, epithelial cancers, borderline or Krukenberg tumors, and benign histology, as well as patients with previous or concomitant cancer, were excluded. RESULTS A total of 150 patients were included in this study. The mean±SD age was 31.45±7.45 years. Histology subtypes were divided into germ cell (n=104, 69.3%), sex-cord (n=41, 27.3%), and other stromal tumors (n=5, 3.3%). Median follow-up time was 58.6 (range: 31.10-81.91) months. Nineteen (12.6%) patients presented with recurrent disease with a median time to recurrence of 19 (range: 6-76) months. Progression-free survival and overall survival did not significantly differ among histology subtypes (p=0.09 and 0.26, respectively) and International Federation of Gynecology and Obstetrics (FIGO) stage (I-II vs III-IV) with p=0.08 and p=0.67, respectively. Univariate analysis identified sex-cord histology with the lowest progression-free survival. Multivariate analysis showed that body mass index (BMI) (HR=1.01; 95% CI 1.00 to 1.01) and sex-cord histology (HR=3.6; 95% CI 1.17 to 10.9) remained important independent prognostic factors for progression-free survival. Independent prognostic factors for overall survival were BMI (HR=1.01; 95% CI 1.00 to 1.01) and residual disease (HR=7.16; 95% CI 1.39 to 36.97). CONCLUSIONS Our study showed that BMI, residual disease, and sex-cord histology were prognostic factors associated with worse oncological outcomes in women younger than 45 years diagnosed with non-epithelial ovarian cancers. Even though the identification of prognostic factors is relevant to identify high-risk patients and guide adjuvant treatment, larger studies with international collaboration are essential to clarify oncological risk factors in this rare disease.
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Affiliation(s)
- Lucas Minig
- Gynecologic Oncology Unit, IMED Hospitales, Valencia, Spain
| | | | - Octavio Arencibia
- Gynecology Department, University Maternal Hospital Canary Islands, Las Palmas, Spain
| | - Cristina Zorrero
- Gynecology Department, CEU Cardenal Herrera University, Moncada, Comunitat Valenciana, Spain
| | - Lola Marti
- Gynecological Oncology, Hospital Universitari de Bellvitge, Hospitalet de Llobregat, Spain
| | | | - Juan Cespedes
- Gynecology Department, Hospital Universitario Donostia, San Sebastian, País Vasco, Spain
| | - Isabel Niguez
- Gynecology Department, Hospital Clínico Universitario Virgen de la Arrixaca, El Palmar, Murcia, Spain
| | - Blanca Gil-Ibanez
- Gynecologic Oncology Unit, Hospital Universitario 12 de Octubre, Madrid, Spain
| | - Berta Diaz-Feijoo
- Gynecologic Oncology Unit, Hospital Clinic de Barcelona, Barcelona, Catalunya, Spain
| | - Soledad Fidalgo
- Gynecology Department, Hospital Universitario Central de Asturias, Oviedo, Asturias, Spain
| | - Irene Valencia
- Gynecology Department, Hospital Universitario de Puerto Real, Puerto Real, Andalucía, Spain
| | | | - Lorena Gonzalez
- Gynecology Department, Hospital Universitario de Torrejón, Torrejon de Ardoz, Madrid, Spain
| | | | - Enrique Chacon
- Gynecologic Oncology, Universidad de Navarra, Pamplona, Navarra, Spain
| | - Isabel Negredo
- Gynecology Department, Miguel Servet University Hospital, Zaragoza, Aragón, Spain
| | - Leticia Azcona Sutil
- Gynecology Department, Hospital Universitario Virgen Macarena, Sevilla, Andalucía, Spain
| | - Mikel Gorostidi
- Gynecology Department, Hospital Universitario Donostia, San Sebastian, País Vasco, Spain
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9
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The Association of Ovarian Teratoma and Anti-N-Methyl-D-Aspartate Receptor Encephalitis: An Updated Integrative Review. Int J Mol Sci 2021; 22:ijms222010911. [PMID: 34681570 PMCID: PMC8535897 DOI: 10.3390/ijms222010911] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2021] [Revised: 09/26/2021] [Accepted: 10/07/2021] [Indexed: 01/09/2023] Open
Abstract
Ovarian teratomas are by far the most common ovarian germ cell tumor. Most teratomas are benign unless a somatic transformation occurs. The designation of teratoma refers to a neoplasm that differentiates toward somatic-type cell populations. Recent research shows a striking association between ovarian teratomas and anti-N-methyl-D-aspartate receptor (anti-NMDAR) encephalitis, a rare and understudied paraneoplastic neurological syndrome (PNS). Among teratomas, mature teratomas are thought to have a greater relevance with those neurological impairments. PNS is described as a neurologic deficit triggered by an underlying remote tumor, whereas anti-NMDAR encephalitis is characterized by a complex neuropsychiatric syndrome and the presence of autoantibodies in cerebral spinal fluid against the GluN1 subunit of the NMDAR. This review aims to summarize recent reports on the association between anti-NMDAR encephalitis and ovarian teratoma. In particular, the molecular pathway of pathogenesis and the updated mechanism and disease models would be discussed. We hope to provide an in-depth review of this issue and, therefore, to better understand its epidemiology, diagnostic approach, and treatment strategies.
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10
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El Helali A, Kwok GST, Tse KY. Adjuvant and post-surgical treatment in non-epithelial ovarian cancer. Best Pract Res Clin Obstet Gynaecol 2021; 78:74-85. [PMID: 34493450 DOI: 10.1016/j.bpobgyn.2021.06.001] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2021] [Accepted: 06/09/2021] [Indexed: 12/14/2022]
Abstract
Non-epithelial cancers arising from the ovary are uncommon malignancies. Germ cell tumors of the ovary arise from primordial germ cells, and sex cord-stromal tumors of the ovary represent a cluster of tumors arising from the sex cord and stromal compartment. Most patients diagnosed with germ cell tumors are young adults and adolescent females. In contrast, ovarian sex cord-stromal tumors more commonly occur in a mature age group. Advances in the adjuvant management of non-epithelial ovarian cancer following optimal surgical and pathological staging have improved patient survival outcomes. In addition, active surveillance is preferentially assigned to patients diagnosed with stage I germ cell tumor, stage 1A grade 1 immature teratoma, stage 1A yolk sac tumor, and stage 1AI sex cord-stromal tumors. This article discusses the importance of selecting the adjuvant treatment approach most suitable to the patients' surgical and pathological stages, thereby safeguarding patient outcomes.
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Affiliation(s)
- Aya El Helali
- Department of Clinical Oncology, University of Hong Kong Li Ka Shing Faculty of Medicine, Queen Mary Hospital, 1/F Professorial Block, 102 Pokfulam Road, Hong Kong.
| | - Gladys Shuk Tak Kwok
- Division of Gynaecology Oncology, Department of Obstetrics and Gynaecology, University of Hong Kong Li Ka Shing Faculty of Medicine, Queen Mary Hospital, 6/F Professorial Block, 102 Pokfulam Road, Hong Kong.
| | - Ka Yu Tse
- Division of Gynaecology Oncology, Department of Obstetrics and Gynaecology, University of Hong Kong Li Ka Shing Faculty of Medicine, Queen Mary Hospital, 6/F Professorial Block, 102 Pokfulam Road, Hong Kong.
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11
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Pokoradi AJ, Agrawal A. Yolk Sac Tumour of the Ovary in Pregnancy Treated With Surgery and Chemotherapy: A Case Report. JOURNAL OF OBSTETRICS AND GYNAECOLOGY CANADA 2021; 43:1177-1179. [PMID: 34000443 DOI: 10.1016/j.jogc.2021.04.013] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2021] [Revised: 04/14/2021] [Accepted: 04/15/2021] [Indexed: 11/17/2022]
Abstract
BACKGROUND Ovarian carcinoma diagnosed in pregnancy is rare. Treatment should take both mother and fetus into consideration. CASE We present the case of a patient diagnosed with a stage IC1 yolk sac tumour of the ovary at 15 weeks gestation, who underwent surgical staging and adjuvant chemotherapy during pregnancy. Intrauterine growth restriction was diagnosed and the patient delivered by cesarean at 36 weeks gestation for obstructed labour. CONCLUSION Yolk sac tumour of the ovary in pregnancy with concomitant chemotherapy is uncommon. Adverse outcomes, including restricted fetal growth, are possible and their identification may help guide timing of delivery.
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Affiliation(s)
- Alida J Pokoradi
- Department of Obstetrics and Gynaecology, Queen's University, Kingston, ON.
| | - Anita Agrawal
- Department of Obstetrics and Gynaecology, Division of Gynaecologic Oncology, Queen's University, Kingston, ON
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12
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Guo H, Chen H, Wang W, Chen L. Clinicopathological Features, Prognostic Factors, Survival Trends, and Treatment of Malignant Ovarian Germ Cell Tumors: A SEER Database Analysis. Oncol Res Treat 2021; 44:145-153. [PMID: 33706324 DOI: 10.1159/000509189] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2020] [Accepted: 06/05/2020] [Indexed: 11/19/2022]
Abstract
OBJECTIVE The aim of this study was to investigate the clinicopathological prognostic factors of malignant ovarian germ cell tumors (MOGCT) and evaluate the survival trends of MOGCT by histotype. METHODS We extracted data on 1,963 MOGCT cases diagnosed between 2000 and 2014 from the Surveillance, Epidemiology, and End Results (SEER) database and the histological classification of MOGCT, including 5 categories: dysgerminoma, embryonal carcinoma (EC), yolk sac tumor, malignant teratoma, and mixed germ cell tumor. We examined overall and disease-specific survival of the 5 histological types. Kaplan-Meier and Cox proportional hazards regression models were used to estimate survival curves and prognostic factors. We also estimated survival curves of MOGCT according to different treatments. RESULTS There was a significant difference in prognosis among different histological classifications. Age, histotype, grade, SEER stage, and surgery were independent prognostic factors for survival of patients with MOGCT. For all histotypes, 1-, 3-, and 5-year survival rate estimates were >85%, except for EC, which had the worst outcomes at 1 year (55.6%), 3 years (44.4%), and 5 years (33.3%). In the distant SEER stage, both chemotherapy and surgery were associated with improved survival outcomes compared with surgery- and chemotherapy-only groups. CONCLUSIONS Dysgerminoma patients had the most favorable outcomes, whereas EC patients had the worst survival. A young age, low grade, and surgery were all significant predictors for improved survival. In contrast, a distant SEER stage was a risk factor for poor survival. Chemotherapy combined with surgery contributed to longer survival times of patients with MOGCT in the distant SEER stage.
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Affiliation(s)
- Hualei Guo
- Department of Pathology, Hangzhou Women's Hospital, Hangzhou, China,
| | - Hao Chen
- Department of Pathology, Hangzhou Women's Hospital, Hangzhou, China
| | - Wenhui Wang
- Department of Pathology, Hangzhou Women's Hospital, Hangzhou, China
| | - Lingna Chen
- Department of Gynecology, Hangzhou Women's Hospital, Hangzhou, China
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13
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Singh P, Singh D, Anant M, Agrawal M, Sinha R. Clinical Characteristics and Treatment Outcomes of Patients with Ovarian Germ Cell Tumor Treated at a Tertiary Care Center in Patna, India. INDIAN JOURNAL OF GYNECOLOGIC ONCOLOGY 2020. [DOI: 10.1007/s40944-020-00401-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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14
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Veneris JT, Mahajan P, Frazier AL. Contemporary management of ovarian germ cell tumors and remaining controversies. Gynecol Oncol 2020; 158:467-475. [DOI: 10.1016/j.ygyno.2020.05.007] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2020] [Accepted: 05/06/2020] [Indexed: 12/19/2022]
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15
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Derquin F, Floquet A, Hardy-Bessard AC, Edeline J, Lotz JP, Alexandre J, Pautier P, Angeles MA, Delanoy N, Lefeuvre-Plesse C, Cancel M, Treilleux I, Augereau P, Lavoue V, Kalbacher E, Berton Rigaud D, Selle F, Nadeau C, Gantzer J, Joly F, Guillemet C, Pomel C, Favier L, Abdeddaim C, Venat-Bouvet L, Provansal M, Fabbro M, Kaminsky MC, Lortholary A, Lecuru F, Coquard IR, de La Motte Rouge T. Need for risk-adapted therapy for malignant ovarian germ cell tumors: A large multicenter analysis of germ cell tumors' patients from French TMRG network. Gynecol Oncol 2020; 158:666-672. [PMID: 32624235 DOI: 10.1016/j.ygyno.2020.06.491] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2020] [Accepted: 06/12/2020] [Indexed: 02/07/2023]
Abstract
BACKGROUND Malignant ovarian germ cell tumors are rare tumors, affecting young women with a generally favorable prognosis. The French reference network for Rare Malignant Gynecological Tumors (TMRG) aims to improve their management. The purpose of this study is to report clinicopathological features and long-term outcomes, to explore prognostic parameters and to help in considering adjuvant strategy for stage I patients. PATIENTS AND METHODS Data from patients with MOGCT registered among 13 of the largest centers of the TMRG network were analyzed. We report clinicopathological features, estimated 5-year event-free survival (5y-EFS) and 5-year overall survival (5y-OS) of MOGCT patients. RESULTS We collected data from 147 patients including 101 (68.7%) FIGO stage I patients. Histology identifies 40 dysgerminomas, 52 immature teratomas, 32 yolk sac tumors, 2 choriocarcinomas and 21 mixed tumors. Surgery was performed in 140 (95.2%) patients and 106 (72.1%) received first line chemotherapy. Twenty-two stage I patients did not receive chemotherapy. Relapse occurred in 24 patients: 13 were exclusively treated with upfront surgery and 11 received surgery and chemotherapy. 5y-EFS was 82% and 5y-OS was 92.4%. Stage I patients who underwent surgery alone had an estimated 5y-EFS of 54.6% and patients receiving adjuvant chemotherapy 94.4% (P < .001). However, no impact on estimated 5y-OS was observed: 96.3% versus 97.8% respectively (P = .62). FIGO stage, complete primary surgery and post-operative alpha fetoprotein level significantly correlated with survival. CONCLUSION Adjuvant chemotherapy does not seem to improve survival in stage I patients. Active surveillance can be proposed for selected patients with a complete surgical staging.
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Affiliation(s)
- F Derquin
- Medical Oncology Department, Centre Hospitaliser Yves Le Foll, Saint Brieuc, France
| | - A Floquet
- Medical Oncology Department, Institut Bergonié, Bordeaux, France
| | | | - J Edeline
- Medical Oncology Department, Centre Eugène Marquis, Rennes, France
| | - J P Lotz
- Medical Oncology Department, Sorbonne University, APHP, Paris, France
| | - J Alexandre
- Medical Oncology Department, Hôpital Cochin, APHP, Paris, France
| | - P Pautier
- Medical Oncology Department, Institut Gustave Roussy, Villejuif, France
| | - M A Angeles
- Surgical Oncology Department, Institut Claudius Regaud, Toulouse, France
| | - N Delanoy
- Medical Oncology Department, Hôpital Européen Georges Pompidou, APHP, Paris, France
| | | | - M Cancel
- Medical Oncology Department, Centre Hospitalier Universitaire Bretonneau, Tours, France
| | - I Treilleux
- Medical Oncology Department, Centre Léon Bérard, Lyon, France
| | - P Augereau
- Medical Oncology Department, Institut de Cancérologie de l'Ouest, Angers, France
| | - V Lavoue
- Gynecology Department, Centre Hospitalier Universitaire, Rennes, France
| | - E Kalbacher
- Medical Oncology Department, Centre Hospitalier Régional Universitaire, Besançon, France
| | - D Berton Rigaud
- Medical Oncology Department, Institut de Cancérologie de l'Ouest, Nantes, France
| | - F Selle
- Diaconnesses Hospital Group, Paris, France
| | - C Nadeau
- Gynecology Department, CHU de Poitiers, Poitiers, France
| | - J Gantzer
- Medical Oncology Department, Hôpitaux Universitaires de Strasbourg, Strasbourg, France
| | - F Joly
- Medical Oncology Department, Centre François Baclesse, Caen, France
| | - C Guillemet
- Medical Oncology Department, Centre Henri-Becquerel, Rouen, France
| | - C Pomel
- Medical Oncology Department, Centre Jean Perrin, Clermont-Ferrand, France
| | - L Favier
- Medical Oncology Department, Centre Georges François Leclerc, Dijon, France
| | - C Abdeddaim
- Medical Oncology Department, Centre Oscar Lambret, Lille, France
| | - L Venat-Bouvet
- Medical Oncology Department, CHU Dupuytren, Limoges, France
| | - M Provansal
- Medical Oncology Department, Institut Paoli Calmettes, Marseille, France
| | - M Fabbro
- Medical Oncology Department, Institut régional du Cancer Montpellier, Montpellier, France
| | - M C Kaminsky
- Medical Oncology Department, Institut de Cancérologie de Lorraine - Alexis Vautrin, Vandoeuvre-Les-Nancy, France
| | - A Lortholary
- Medical Oncology Department, Hôpital Privé du Confluent, Nantes, France
| | - F Lecuru
- Medical Oncology Department, Hôpital Européen Georges Pompidou, APHP, Paris, France
| | - I Ray Coquard
- Medical Oncology Department, Centre Léon Bérard, Lyon, France
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16
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De Giorgi U, Casadei C, Bergamini A, Attademo L, Cormio G, Lorusso D, Pignata S, Mangili G. Therapeutic Challenges for Cisplatin-Resistant Ovarian Germ Cell Tumors. Cancers (Basel) 2019; 11:cancers11101584. [PMID: 31627378 PMCID: PMC6826947 DOI: 10.3390/cancers11101584] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2019] [Revised: 10/10/2019] [Accepted: 10/15/2019] [Indexed: 12/13/2022] Open
Abstract
The majority of patients with advanced ovarian germ cell cancer are treated by cisplatin-based chemotherapy. Despite adequate first-line treatment, nearly one third of patients relapse and almost half develop cisplatin-resistant disease, which is often fatal. The treatment of cisplatin-resistant disease is challenging and prognosis remains poor. There are limited data on the efficacy of specific chemotherapeutic regimens, high-dose chemotherapy with autologous progenitor cell support and targeted therapies. The inclusion of patients in clinical trials is strongly recommended, especially in clinical trials on the most frequent male germ cell tumors, to offer wider therapeutic opportunities. Here, we provide an overview of current and potential new treatment options including combination chemotherapy, high-dose chemotherapy and molecular targeted therapies, for patients with cisplatin-resistant ovarian germ cell tumors.
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Affiliation(s)
- Ugo De Giorgi
- Department of Medical Oncology and Hematology, Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori (IRST) IRCCS, 47014 Meldola, Italy.
| | - Chiara Casadei
- Department of Medical Oncology and Hematology, Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori (IRST) IRCCS, 47014 Meldola, Italy.
| | - Alice Bergamini
- Department of Obstetrics and Gynaecology, San Raffaele Scientific Institute, 20132 Milan, Italy.
| | - Laura Attademo
- Department of Urology and Gynecology, Istituto Nazionale Tumori IRCCS Fondazione G. Pascale, 80138 Naples, Italy.
| | - Gennaro Cormio
- Gynecologic Oncology Unit, IRCCS Istituto Oncologico Giovanni Paolo II, 70124 Bari, Italy.
| | - Domenica Lorusso
- Gynecologic Oncology Unit, Department of Woman, Child Health and Public Health, Fondazione Policlinico Universitario Agostino Gemelli, IRCCS, 00168 Rome, Italy.
| | - Sandro Pignata
- Department of Urology and Gynecology, Istituto Nazionale Tumori IRCCS Fondazione G. Pascale, 80138 Naples, Italy.
| | - Giorgia Mangili
- Department of Obstetrics and Gynaecology, San Raffaele Scientific Institute, 20132 Milan, Italy.
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17
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Bandala-Jacques A, Estrada-Rivera F, Cantu D, Prada D, Montalvo-Esquivel G, González-Enciso A, Barquet-Munoz SA. Role of optimal cytoreduction in patients with dysgerminoma. Int J Gynecol Cancer 2019; 29:1405-1410. [PMID: 31594835 DOI: 10.1136/ijgc-2019-000632] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2019] [Revised: 07/25/2019] [Accepted: 07/26/2019] [Indexed: 12/22/2022] Open
Abstract
BACKGROUND Dysgerminomas are malignant ovarian germ-cell tumors that typically affect young women. Although these tumors have an excellent response to chemotherapy, surgery is an integral part of primary treatment. OBJECTIVE To evaluate outcomes of initial cytoreduction in patients diagnosed with dysgerminomas. METHODS Patients who underwent primary cytoreductive surgery for ovarian dysgerminoma between January 1985 and December 2013 were identified and included in the study. A comparison was made between patients who underwent optimal versus sub-optimal cytoreduction. Descriptive, comparative statistics and odds ratios were used to establish an association. Survival curves were performed with the Kaplan-Meier method and compared using a log-rank test. A value of p<0.05 was used to establish a statistical difference. RESULTS A total of 180 patients with a histologically confirmed dysgerminoma were included in the analysis. A subsection of 37 patients in stages III/IV were analyzed. The median age at diagnosis was 21 years (IQR 18-26). Histologically, 166 (92.2%) patients had pure dysgerminomas, whereas the rest had mixed histologies. The median tumor size was 18 (IQR 12-22) cm. In all stages, factors associated with optimal cytoreduction, were higher lactate dehydrogenase levels (OR=1.01; p=0.03), higher CA125 levels (OR=1.01; p=0.04), receiving adjuvant chemotherapy (OR=0.22; p<0.01), or undergoing treatment in a specialized institution (OR=12.68; p<0.01). Patients in stages III/IV, initially managed outside our institution were less likely to be taken for cytoreduction (OR=16.88; p=0.013). Other factors, including age (OR=1.02; p=0.39), pelvic lymph-node positivity (OR=2.24; p=0.36), pregnancy during follow-up (OR=0.91: p=0.80), or recurrence of disease (OR=1.93; p=0.23) were found to be similar in both groups. Overall survival was higher in optimally cytoreducted patients (100% vs 95.7%; p=0.032) including all stages, but not if considering only stages III/IV (100% vs 90%, p=0.186); disease-free survival was the same for both groups regardless of stage (94.3% vs 91.1%; p=0.36). CONCLUSION Patients with optimal surgeries were most likely to be treated in referral centers. Initial residual disease did not significantly alter recurrence, progression, disease-free survival, or overall survival.
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Affiliation(s)
- Antonio Bandala-Jacques
- Departamento de Ginecología, Instituto Nacional de Cancerología, Mexico City, Mexico.,Unidad de Investigación Biomédica en Cáncer, Instituto Nacional de Cancerología, Mexico City, Mexico
| | - Fabiola Estrada-Rivera
- Departamento de Ginecología, Instituto Nacional de Cancerología, Mexico City, Mexico.,Unidad de Investigación Biomédica en Cáncer, Instituto Nacional de Cancerología, Mexico City, Mexico
| | - David Cantu
- Departamento de Ginecología, Instituto Nacional de Cancerología, Mexico City, Mexico
| | - Diddier Prada
- Unidad de Investigación Biomédica en Cáncer, Instituto Nacional de Cancerología, Mexico City, Mexico.,Departamento de Informática Biomédica, Facultad de Medicina, Universidad Nacional Autonoma de Mexico, Mexico City, Mexico
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18
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Olson TA. Adolescents and Cancer Clinical Trials: A MaGIC Mystery Tour. J Oncol Pract 2019; 15:443-444. [PMID: 31404516 DOI: 10.1200/jop.19.00416] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
- Thomas A Olson
- 1Aflac Cancer and Blood Disorders Center, Children's Healthcare of Atlanta, Atlanta, GA.,2Emory University School of Medicine, Atlanta, GA
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19
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Newton C, Murali K, Ahmad A, Hockings H, Graham R, Liberale V, Sarker SJ, Ledermann J, Berney DM, Shamash J, Banerjee S, Stoneham S, Lockley M. A multicentre retrospective cohort study of ovarian germ cell tumours: Evidence for chemotherapy de-escalation and alignment of paediatric and adult practice. Eur J Cancer 2019; 113:19-27. [PMID: 30954883 PMCID: PMC6522056 DOI: 10.1016/j.ejca.2019.03.001] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2018] [Revised: 02/14/2019] [Accepted: 03/02/2019] [Indexed: 12/22/2022]
Abstract
BACKGROUND Adult guidelines recommend BEP (bleomycin, etoposide, cisplatin) for all ovarian germ cell tumours, causing debilitating toxicities in young patients who will survive long term. Paediatricians successfully reduce toxicities by using lower bleomycin doses and substituting carboplatin for cisplatin, while testicular and paediatric immature teratomas (ITs) are safely managed with surgery alone. AIM The aim was to determine whether reduced-toxicity treatment could rationally be extended to patients older than 18 years. METHODS Multicentre cohort study was carried out in four large UK cancer centres over 12 years. RESULTS One hundred thirty-eight patients were enrolled. Overall survival was 93%, and event-free survival (EFS) was 72%. Neoadjuvant/adjuvant chemotherapy (82% BEP) caused 27 potentially chronic toxicities, and one patient subsequently died from acute lymphoblastic leukaemia. There was no difference in histology, stage or grade in patients ≤/>18 years, and EFS was not different in these age groups (≤18:28% and >18:28%; log-rank P = 0.96). Histological subtype powerfully predicted EFS (log-rank P = 4.9 × 10-7). Neoadjuvant/adjuvant chemotherapy reduced future relapse/progression in dysgerminoma (n = 37, chemo:0% vs. no chemo:20%), yolk sac tumour (n = 23, 26.3% vs.75%) and mixed germ cell tumour (n = 32, 40%vs.70%) but not in IT (n = 42, 33% vs.15%). Additionally, we observed no radiological responses to chemotherapy in ITs, pathological IT grade did not predict EFS (univariate hazard ratio 0.82, 95% confidence interval: 0.57-1.19, P = 0.94) and there were no deaths in this subtype. CONCLUSION Survival was excellent but chemotherapy toxicities were severe, implying significant overtreatment. Our data support the extension of reduced-toxicity, paediatric regimens to adults. Our practice-changing findings that IT was chemotherapy resistant and pathological grade uninformative strongly endorse exclusive surgical management of ovarian ITs at all ages.
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Affiliation(s)
- C Newton
- Barts Health NHS Trust, West Smithfield, London, EC1A 7BE, UK; University College Hospital, 235 Euston Road London, NW1 2BU, UK; University Hospitals Bristol NHS Foundation Trust, Upper Maudlin Street, Bristol, BS2 8HW, UK; University of Bristol, Senate House, Tyndall Avenue, Bristol BS8 1TH, UK
| | - K Murali
- The Royal Marsden Hospital, 203 Fulham Rd, Chelsea, London SW3 6JJ, UK
| | - A Ahmad
- The Wolfson Institute, CRUK Barts Cancer Centre, Queen Mary University London, Charterhouse Square, London EC1M 6BQ, UK; Cancer Intelligence, Cancer Research UK, Angel Building, 407 St John Street, London EC1V 4AD, UK
| | - H Hockings
- Barts Health NHS Trust, West Smithfield, London, EC1A 7BE, UK; Centre for Molecular Oncology, Barts Cancer Institute, Queen Mary University of London, Charterhouse Square, London EC1M 6BQ, UK
| | - R Graham
- University College Hospital, 235 Euston Road London, NW1 2BU, UK
| | - V Liberale
- University College Hospital, 235 Euston Road London, NW1 2BU, UK
| | - S-J Sarker
- Centre for Molecular Oncology, Barts Cancer Institute, Queen Mary University of London, Charterhouse Square, London EC1M 6BQ, UK; Research Department of Medical Education, UCL Medical School, Royal Free Campus, Hampstead, London NW3 2PR, UK
| | - J Ledermann
- University College Hospital, 235 Euston Road London, NW1 2BU, UK
| | - D M Berney
- Barts Health NHS Trust, West Smithfield, London, EC1A 7BE, UK; Centre for Molecular Oncology, Barts Cancer Institute, Queen Mary University of London, Charterhouse Square, London EC1M 6BQ, UK
| | - J Shamash
- Barts Health NHS Trust, West Smithfield, London, EC1A 7BE, UK
| | - S Banerjee
- The Royal Marsden Hospital, 203 Fulham Rd, Chelsea, London SW3 6JJ, UK
| | - S Stoneham
- University College Hospital, 235 Euston Road London, NW1 2BU, UK
| | - M Lockley
- Barts Health NHS Trust, West Smithfield, London, EC1A 7BE, UK; University College Hospital, 235 Euston Road London, NW1 2BU, UK; Centre for Molecular Oncology, Barts Cancer Institute, Queen Mary University of London, Charterhouse Square, London EC1M 6BQ, UK.
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20
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Acosta AM, Pins MR. Hepatoid Carcinoma of the Ovary: Clinical, Histopathologic, and Immunophenotypic Features. Arch Pathol Lab Med 2019; 143:883-889. [PMID: 30628840 DOI: 10.5858/arpa.2017-0485-rs] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Hepatoid carcinoma of the ovary (HCO) is a rare malignant tumor of uncertain histogenesis that was first described by Ishikura and Scully in the late 1980s. Unlike hepatoid yolk sac tumor (HYST), one of its main differential diagnoses, HCO usually presents in perimenopausal and postmenopausal women without gonadal dysgenesis. Most cases show advanced local disease at initial presentation, with diffuse intraperitoneal dissemination. Despite aggressive treatment, including surgery and adjuvant chemotherapy, 61.5% of patients either die of the disease (11 of 26; 42.3%) or are alive with recurrent or residual disease (5 of 26; 19.2%) after a median follow-up of 11.5 months (range, 1-60 months). Most HCOs are solid, with high-grade histology, significant nuclear pleomorphism, scattered giant cells, and a high mitotic index. Their immunophenotype is defined by the expression of broad-spectrum cytokeratins, α-fetoprotein, and hepatocellular antigens with absence of sex cord and germ cell markers. Although immunohistochemistry can be very helpful to distinguish between sex cord-stromal tumors and HCO, differentiation of the latter from HYST, metastatic hepatocellular carcinoma, and metastatic gastrointestinal tumors with hepatoid phenotype requires integration of clinical, radiologic, and pathologic information.
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Affiliation(s)
- Andres M Acosta
- From the University of Illinois at Chicago (Dr Acosta); the Chicago Medical School of Rosalind Franklin University of Medicine and Science, North Chicago, Illinois (Dr Pins); and the Advocate Lutheran General Hospital and the James R. & Helen D. Russell Institute for Research & Innovation, Park Ridge, Illinois (Dr Pins)
| | - Michael R Pins
- From the University of Illinois at Chicago (Dr Acosta); the Chicago Medical School of Rosalind Franklin University of Medicine and Science, North Chicago, Illinois (Dr Pins); and the Advocate Lutheran General Hospital and the James R. & Helen D. Russell Institute for Research & Innovation, Park Ridge, Illinois (Dr Pins)
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21
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Lawrence NJ, Chan H, Toner G, Stockler MR, Martin A, Yip S, Wong N, Yeung A, Mazhar D, Pashankar F, Frazier L, McDermott R, Walker R, Tan H, Davis ID, Grimison P. Protocol for the P3BEP trial (ANZUP 1302): an international randomised phase 3 trial of accelerated versus standard BEP chemotherapy for adult and paediatric male and female patients with intermediate and poor-risk metastatic germ cell tumours. BMC Cancer 2018; 18:854. [PMID: 30157803 PMCID: PMC6114870 DOI: 10.1186/s12885-018-4745-3] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2017] [Accepted: 08/13/2018] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND Bleomycin, etoposide, and cisplatin (BEP) chemotherapy administered every 3 weeks for 4 cycles remains the standard first line treatment for patients with intermediate- and poor-risk metastatic germ cell tumours (GCTs). Administering standard chemotherapy 2-weekly rather than 3-weekly, so-called 'accelerating chemotherapy', has improved cure rates in other cancers. An Australian multicentre phase 2 trial demonstrated this regimen is feasible and tolerable with efficacy data that appears promising. The aim of this trial is to determine if accelerated BEP is superior to standard BEP as first line chemotherapy for adult and paediatric male and female participants with intermediate and poor risk metastatic GCTs. METHODS This is an open label, randomised, stratified, 2-arm, international multicentre, 2 stage, phase 3 clinical trial. Participants are randomised 1:1 to receive accelerated BEP or standard BEP chemotherapy. Eligible male or female participants, aged between 11 and 45 years with intermediate or poor-risk metastatic GCTs for first line chemotherapy will be enrolled from Australia, the United Kingdom and the United States. Participants will have regular follow up for at least 5 years. The primary endpoint for stage 1 of the trial (n = 150) is complete response rate and for the entire trial (n = 500) is progression free survival. Secondary endpoints include response following treatment completion (by a protocol-specific response criteria), adverse events, health-related quality of life, treatment preference, delivered dose-intensity of chemotherapy (relative to standard BEP), overall survival and associations between biomarkers (to be specified) and their correlations with clinical outcomes. DISCUSSION This is the first international randomised clinical trial for intermediate and poor-risk metastatic extra-cranial GCTs involving both adult and pediatric age groups open to both males and females. It is also the largest, current randomised trial for germ cell tumours in the world. Positive results for this affordable intervention could change the global standard of care for intermediate and poor risk germ cell tumours, improve cure rates, avoid the need for toxic and costly salvage treatment, and return young adults to long, healthy and productive lives. TRIAL REGISTRATION ACTRN 12613000496718 on 3rd May 2013 and Clinicaltrials.gov NCT02582697 on 21st October 2015.
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Affiliation(s)
- Nicola J. Lawrence
- Australian and New Zealand Urogenital and Prostate Cancer Trials Group, Sydney, NSW Australia
- NHMRC Clinical Trials Centre, Lifehouse Level 6, 119–143 Missenden Road, Camperdown, NSW 2050 Australia
| | - Howard Chan
- Australian and New Zealand Urogenital and Prostate Cancer Trials Group, Sydney, NSW Australia
- NHMRC Clinical Trials Centre, Lifehouse Level 6, 119–143 Missenden Road, Camperdown, NSW 2050 Australia
| | - Guy Toner
- Australian and New Zealand Urogenital and Prostate Cancer Trials Group, Sydney, NSW Australia
- Peter MacCallum Cancer Centre, University of Melbourne, Melbourne, Australia
| | - Martin R. Stockler
- Australian and New Zealand Urogenital and Prostate Cancer Trials Group, Sydney, NSW Australia
- NHMRC Clinical Trials Centre, Lifehouse Level 6, 119–143 Missenden Road, Camperdown, NSW 2050 Australia
- Chris O’Brien Lifehouse, 119–143 Missenden Road, Camperdown, NSW 2050 Australia
- Concord Cancer Centre, Concord Repatriation General Hospital, Sydney, NSW Australia
| | - Andrew Martin
- Australian and New Zealand Urogenital and Prostate Cancer Trials Group, Sydney, NSW Australia
- NHMRC Clinical Trials Centre, Lifehouse Level 6, 119–143 Missenden Road, Camperdown, NSW 2050 Australia
| | - Sonia Yip
- Australian and New Zealand Urogenital and Prostate Cancer Trials Group, Sydney, NSW Australia
- NHMRC Clinical Trials Centre, Lifehouse Level 6, 119–143 Missenden Road, Camperdown, NSW 2050 Australia
- Sydney Catalyst Translational Cancer Research Centre, University of Sydney, Camperdown, NSW Australia
| | - Nicole Wong
- Australian and New Zealand Urogenital and Prostate Cancer Trials Group, Sydney, NSW Australia
- NHMRC Clinical Trials Centre, Lifehouse Level 6, 119–143 Missenden Road, Camperdown, NSW 2050 Australia
| | - Annie Yeung
- Australian and New Zealand Urogenital and Prostate Cancer Trials Group, Sydney, NSW Australia
- NHMRC Clinical Trials Centre, Lifehouse Level 6, 119–143 Missenden Road, Camperdown, NSW 2050 Australia
| | - Danish Mazhar
- Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
| | - Farzana Pashankar
- Australian and New Zealand Urogenital and Prostate Cancer Trials Group, Sydney, NSW Australia
- Yale University School of Medicine, New Haven, CT USA
| | - Lindsay Frazier
- Australian and New Zealand Urogenital and Prostate Cancer Trials Group, Sydney, NSW Australia
- Dana-Farber Cancer Institute and Boston Children’s Hospital, Boston, MA USA
| | - Ray McDermott
- Australian and New Zealand Urogenital and Prostate Cancer Trials Group, Sydney, NSW Australia
- Cancer Trials Ireland, Dublin, Ireland
| | - Roderick Walker
- Australian and New Zealand Urogenital and Prostate Cancer Trials Group, Sydney, NSW Australia
- Lady Cilento Children’s Hospital, Brisbane, QLD Australia
- Princess Alexandra Hospital, Brisbane, QLD Australia
| | - Hsiang Tan
- Australian and New Zealand Urogenital and Prostate Cancer Trials Group, Sydney, NSW Australia
- Royal Adelaide Hospital, Adelaide, South Australia Australia
| | - Ian D. Davis
- Australian and New Zealand Urogenital and Prostate Cancer Trials Group, Sydney, NSW Australia
- Monash University Eastern Health Clinical School, Melbourne, VIC Australia
| | - Peter Grimison
- Australian and New Zealand Urogenital and Prostate Cancer Trials Group, Sydney, NSW Australia
- Chris O’Brien Lifehouse, 119–143 Missenden Road, Camperdown, NSW 2050 Australia
| | - on behalf of ANZUP
- Australian and New Zealand Urogenital and Prostate Cancer Trials Group, Sydney, NSW Australia
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Zogbi L, Gonçalves CV, Tejada VF, Martins D, Karam F, Machado Dos Santos S, Caldeira RR, Senhorin GZ, Lauz S. Treatment of bilateral ovarian dysgerminoma with 11-year follow-up: A case report. Ann Med Surg (Lond) 2018; 33:50-52. [PMID: 30186597 PMCID: PMC6122391 DOI: 10.1016/j.amsu.2018.08.009] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2018] [Revised: 07/04/2018] [Accepted: 08/13/2018] [Indexed: 01/30/2023] Open
Abstract
Introduction Malignant ovarian germ cell tumors (MOGCTs) are rare malignancies with an incidence of about 0.5/100,000. They account for less than 5% of all ovarian tumors, of which 32.8% are dysgerminomas, the female analogue of seminomas. These tumors occur in all age groups, with peak incidence below the age of 20 years in women. Aim To describe the case of a bilateral ovarian dysgerminoma treatment with 11-year follow-up. Methods Case report with details regarding clinical history, surgical treatment, chemotherapy and follow up. We include a brief literature review. Results The patient underwent radical surgery for an advanced dysgerminoma, 20 cm in length, that compromised the contralateral ovary and sigmoid. Neoplastic cells were found in ascitic fluid. Subsequently, she underwent adjuvant chemotherapy according to a standard protocol. She has survived disease-free for more than 11 years. Conclusions Dysgerminoma is a malignant neoplasm that, similar to other cancers, is easier to treat when diagnosed early. However, cures may be obtained even in advanced cases.
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Affiliation(s)
- Luciano Zogbi
- Faculdade de Medicina (FAMED) - Universidade Federal do Rio Grande (FURG), Rio Grande city, Rio Grande do Sul State, Brazil
| | - Carla Vitola Gonçalves
- Faculdade de Medicina (FAMED) - Universidade Federal do Rio Grande (FURG), Rio Grande city, Rio Grande do Sul State, Brazil
| | - Victor Felipe Tejada
- Faculdade de Medicina (FAMED) - Universidade Federal do Rio Grande (FURG), Rio Grande city, Rio Grande do Sul State, Brazil
| | - Daiane Martins
- Faculdade de Medicina (FAMED) - Universidade Federal do Rio Grande (FURG), Rio Grande city, Rio Grande do Sul State, Brazil
| | - Fabine Karam
- Faculdade de Medicina (FAMED) - Universidade Federal do Rio Grande (FURG), Rio Grande city, Rio Grande do Sul State, Brazil
| | - Sílvia Machado Dos Santos
- Faculdade de Medicina (FAMED) - Universidade Federal do Rio Grande (FURG), Rio Grande city, Rio Grande do Sul State, Brazil
| | - Roberta Raseira Caldeira
- Faculdade de Medicina (FAMED) - Universidade Federal do Rio Grande (FURG), Rio Grande city, Rio Grande do Sul State, Brazil
| | - Gisele Zanetti Senhorin
- Faculdade de Medicina (FAMED) - Universidade Federal do Rio Grande (FURG), Rio Grande city, Rio Grande do Sul State, Brazil
| | - Susi Lauz
- Faculdade de Medicina (FAMED) - Universidade Federal do Rio Grande (FURG), Rio Grande city, Rio Grande do Sul State, Brazil
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23
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De Giorgi U, Richard S, Badoglio M, Kanfer E, Bourrhis JH, Nicolas-Virelizier E, Vettenranta K, Lioure B, Martin S, Dreger P, Schuler MK, Thomson K, Scarpi E, Rosti G, Selle F, Mangili G, Lanza F, Bregni M. Salvage high-dose chemotherapy in female patients with relapsed/refractory germ-cell tumors: a retrospective analysis of the European Group for Blood and Marrow Transplantation (EBMT). Ann Oncol 2018; 28:1910-1916. [PMID: 28510616 DOI: 10.1093/annonc/mdx259] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
Background High-dose chemotherapy (HDC) with hematopoietic progenitor cell transplantation is a standard option for relapsed/refractory testicular germ-cell tumor (GCT), but only few data have been reported in female patients with GCT. We conducted a retrospective analysis of female patients with GCT treated with HDC and registered with the European Society for Blood and Marrow Transplantation. Patients and methods Between 1985 and 2013, 60 registered female patients with GCT, median age 27 years (range 15-48), were treated with salvage HDC. Forty patients (67%) had primary ovarian GCT, 8 (13%) mediastinal, 7 (12%) retroperitoneal and 5 (8%) other primary sites/unknown. Twenty-two patients (37%) received HDC as second-line therapy, 29 (48%) as third-line, and 9 (15%) as fourth- to sixth-line. Nine of 60 patients (15%) received HDC as late-intensification with no evidence of metastasis before HDC. The conditioning HDC regimens comprised carboplatin in 51 of 60 cases (85%), and consisted of a single HDC cycle in 31 cases (52%), a multi-cycle HDC regimen in 29 (48%). Results Nine cases who underwent late intensification HDC were not evaluable for response. Of the other 51 assessable patients, 17 (33%) achieved a complete response (CR), 8 (16%) a marker-negative partial remission (PRm-), 5 (10%) a marker-positive partial remission, 5 (10%) stable disease, and 13 (25%) progressive disease. There were 3 toxic deaths (6%). With an overall median follow-up of 14 months (range 1-219), 7 of 9 (78%) patients with late intensification and 18 of the 25 patients (72%) achieving a CR/PRm- following HDC were free of relapse/progression. In total, 25 of 60 patients (42%) were progression-free following HDC at a median follow-up of 87 months (range 3-219 months). Conclusions Salvage HDC based on carboplatin represents a therapeutic option for female patients with relapsed/refractory GCT.
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Affiliation(s)
- U De Giorgi
- Department of Medical Oncology and Hematology, Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori (IRST) IRCCS, Meldola, Italy
| | - S Richard
- Department of Medical Oncology, Hopital Tenon, Paris
| | | | - E Kanfer
- Department of Hematology, Imperial College, Hammersmith Hospital, London, UK
| | - J H Bourrhis
- Hematology-Marrow Transplant Service, Institute Gustave-Roussy, Villejuif
| | | | - K Vettenranta
- Department of Pediatrics, University of Helsinki, Helsinki, Finland
| | - B Lioure
- Department of Hematology/Oncology, Strasbourg University Hospital, Strasbourg, France
| | - S Martin
- Department of Internal Medicine II, Robert-Bosch-Hospital, Stuttgart
| | - P Dreger
- Department of Medicine V, University of Heidelberg, Heidelberg
| | - M K Schuler
- Department of Internal Medicine I, University Hospital Carl Gustav Carus, Technical University Dresden, Dresden, Germany
| | - K Thomson
- Department of Haematology, University College London Hospital, London, UK
| | - E Scarpi
- Biostatistics and Clinical Trials Unit, Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori (IRST) IRCCS, Meldola
| | - G Rosti
- Department of Oncology, Policlinico San Matteo IRCCS, Pavia
| | - F Selle
- Department of Medical Oncology, Hopital Tenon, Paris
| | - G Mangili
- Department of Obstetrics and Gynaecology, San Raffaele Scientific Institute, Milan
| | - F Lanza
- Department of Onco-Hematology, Santa Maria delle Croci Hospital, Ravenna
| | - M Bregni
- Department of Medical Oncology, Busto Arsizio Hospital, Busto Arsizio, Italy
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24
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Di Tucci C, Casorelli A, Morrocchi E, Palaia I, Muzii L, Panici PB. Fertility management for malignant ovarian germ cell tumors patients. Crit Rev Oncol Hematol 2017; 120:34-42. [DOI: 10.1016/j.critrevonc.2017.10.005] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2017] [Revised: 08/23/2017] [Accepted: 10/11/2017] [Indexed: 01/02/2023] Open
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25
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Terenziani M, Bisogno G, Boldrini R, Cecchetto G, Conte M, Boschetti L, De Pasquale MD, Biasoni D, Inserra A, Siracusa F, Basso ME, De Leonardis F, Di Pinto D, Barretta F, Spreafico F, D'Angelo P. Malignant ovarian germ cell tumors in pediatric patients: The AIEOP (Associazione Italiana Ematologia Oncologia Pediatrica) study. Pediatr Blood Cancer 2017; 64. [PMID: 28449306 DOI: 10.1002/pbc.26568] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/06/2016] [Revised: 11/30/2016] [Accepted: 03/06/2017] [Indexed: 02/01/2023]
Abstract
OBJECTIVE Malignant ovarian germ cell tumors (MOGCT) carry an excellent prognosis, and the treatment aims to achieve results with the least possible treatment-related morbidity. The aim of this study was to assess the outcomes of pediatric patients with MOGCT. METHODS Patients were treated according to their stage: surgery and surveillance for stage I; a modified bleomycin-etoposide-cisplatin (BEP) regimen for stages II (three cycles), III, and IV (three cycles) with surgery on residual disease. RESULTS Seventy-seven patients were enrolled (median age 11.8 years), 26 with dysgerminoma (Dysg), 13 with immature teratoma and elevated serum alpha-fetoprotein levels (IT + AFP), and 38 with nondysgeminoma (Non-Dysg) staged as follows: 27 stage I, 13 stage II, 32 stage III, 5 stage IV. Among evaluable patients in stage I (5-year event-free survival [EFS] 72.1% [95% CI: 56.4-92.1%]; 5-year overall survival [OS] 100%), seven relapsed (three patients with Dysg and four patients with Non-Dysg) and were rescued with chemotherapy (plus surgery in three patients). Among the evaluable patients with stages II-IV, 48 (98%) achieved complete remission after chemotherapy ± surgery, one (IT + AFP, stage IV) had progressive disease. In the whole series (median follow-up 80 months), the 5-year OS and EFS were 98.5% (95% CI: 95.6-100%) and 84.5% (95% CI: 76.5-93.5%). CONCLUSIONS We confirm the excellent outcome for MOGCT. Robust data are lacking on surgical staging, surveillance for Non-Dysg with stage I, the management of IT + AFP, and the most appropriate BEP regimen. As pediatric oncologists, we support the role of surveillance after proper surgical staging providing cases are managed by experts at specialized pediatric centers.
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Affiliation(s)
- M Terenziani
- Pediatric Oncology Unit, Fondazione IRCCS Istituto Nazionale dei Tumori di Milano, Italy
| | - G Bisogno
- Pediatric Unit, University-Hospital of Padua, Padova, Italy
| | - R Boldrini
- Pathology Unit, Ospedale Pediatrico Bambino Gesù-IRCCS. Roma, Italy
| | - G Cecchetto
- Pediatric Surgery Unit, University-Hospital of Padua, Padova, Italy
| | - M Conte
- Oncology Unit, Ospedale Pediatrico G. Gaslini, Genova, Italy
| | - L Boschetti
- Pediatric Oncology Unit, Fondazione IRCCS Istituto Nazionale dei Tumori di Milano, Italy
| | - M D De Pasquale
- Hematology/Oncology Department, Ospedale Pediatrico Bambino Gesù-IRCCS, Roma, Italy
| | - D Biasoni
- Pediatric Surgery Unit, Fondazione IRCCS Istituto Nazionale dei Tumori di Milano, Italy
| | - A Inserra
- Pediatric Surgery Department, Ospedale Pediatrico Bambino Gesù-IRCCS, Roma, Italy
| | - F Siracusa
- Pediatric Surgery Department, Università of Palermo, Palermo, Italy
| | - M E Basso
- Hematology/Oncology Unit, Ospedale Infantile Regina Margherita, Torino, Italy
| | - F De Leonardis
- Division of Pediatric Hematology-Oncology, University of Bari, Italy
| | - D Di Pinto
- Pediatric Oncology Unit, Seconda Università, Napoli, Italy
| | - F Barretta
- Unit of Clinical Epidemiology and Trial Organization, Fondazione IRCCS Istituto Nazionale dei Tumori di Milano, Italy
| | - F Spreafico
- Pediatric Oncology Unit, Fondazione IRCCS Istituto Nazionale dei Tumori di Milano, Italy
| | - P D'Angelo
- Hematology/Oncology Unit, A.R.N.A.S Civico Di Cristina e Benfratelli, Palermo, Italy
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Turkmen O, Karalok A, Basaran D, Kimyon GC, Tasci T, Ureyen I, Tulunay G, Turan T. Fertility-Sparing Surgery Should Be the Standard Treatment in Patients with Malignant Ovarian Germ Cell Tumors. J Adolesc Young Adult Oncol 2017; 6:270-276. [DOI: 10.1089/jayao.2016.0086] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023] Open
Affiliation(s)
- Osman Turkmen
- Department of Gynecologic Oncology, Etlik Zubeyde Hanim Women's Health Teaching and Research Hospital, Ankara, Turkey
| | - Alper Karalok
- Department of Gynecologic Oncology, Etlik Zubeyde Hanim Women's Health Teaching and Research Hospital, Ankara, Turkey
| | - Derman Basaran
- Department of Gynecologic Oncology, Etlik Zubeyde Hanim Women's Health Teaching and Research Hospital, Ankara, Turkey
| | - Gunsu Comert Kimyon
- Department of Gynecologic Oncology, Etlik Zubeyde Hanim Women's Health Teaching and Research Hospital, Ankara, Turkey
| | - Tolga Tasci
- Department of Gynecologic Oncology, Etlik Zubeyde Hanim Women's Health Teaching and Research Hospital, Ankara, Turkey
| | - Isin Ureyen
- Department of Gynecologic Oncology, Etlik Zubeyde Hanim Women's Health Teaching and Research Hospital, Ankara, Turkey
| | - Gokhan Tulunay
- Department of Gynecologic Oncology, Etlik Zubeyde Hanim Women's Health Teaching and Research Hospital, Ankara, Turkey
| | - Taner Turan
- Department of Gynecologic Oncology, Etlik Zubeyde Hanim Women's Health Teaching and Research Hospital, Ankara, Turkey
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Stein EB, Wasnik AP, Sciallis AP, Kamaya A, Maturen KE. MR Imaging-Pathologic Correlation in Ovarian Cancer. Magn Reson Imaging Clin N Am 2017; 25:545-562. [PMID: 28668159 DOI: 10.1016/j.mric.2017.03.004] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
There are many ovarian cancer subtypes, giving rise to a range of appearances at gross pathology and magnetic resonance (MR) imaging. Certain fundamental concepts at MR, arising from underlying tissue characteristics, can provide guidance to radiologists in suggesting a diagnosis. The ability of multiparametric MR to risk stratify ovarian masses can contribute substantially to clinical decision making and patient management.
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Affiliation(s)
- Erica B Stein
- Department of Radiology, University of Michigan, 1500 East Medical Center Drive, Ann Arbor, MI 48109, USA; Department of Radiology, University of Pittsburgh Medical Center, 200 Lothrop Street, Pittsburgh, PA 15213, USA.
| | - Ashish P Wasnik
- Department of Radiology, University of Michigan, 1500 East Medical Center Drive, Ann Arbor, MI 48109, USA
| | - Andrew P Sciallis
- Department of Pathology, University of Michigan, 1500 East Medical Center Drive, Ann Arbor, MI 48109, USA
| | - Aya Kamaya
- Department of Radiology, Stanford University, 300 Pasteur Drive, Stanford, CA 94305, USA
| | - Katherine E Maturen
- Department of Radiology, University of Michigan, 1500 East Medical Center Drive, Ann Arbor, MI 48109, USA; Department of Obstetrics & Gynecology, University of Michigan, 1500 East Medical Center Drive, Ann Arbor, MI 48109, USA
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28
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Gonzalez-Billalabeitia E, Castellano D, Sobrevilla N, Guma J, Hervas D, Luengo MI, Aparicio J, Sanchez-Muñoz A, Mellado B, Saenz A, Valverde C, Fernandez A, Margeli M, Duran I, Fernandez S, Sastre J, Ros S, Maroto P, Manneh R, Cerezuela P, Carmona-Bayonas A, Ayala de la Peña F, Luis Aguilar J, Rivera S, García Del Muro X, Germà-Lluch JR. Prognostic Significance of Venous Thromboembolic Events in Disseminated Germ Cell Cancer Patients. J Natl Cancer Inst 2017; 109:2957313. [PMID: 28122896 DOI: 10.1093/jnci/djw265] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2016] [Revised: 08/26/2016] [Accepted: 10/06/2016] [Indexed: 12/29/2022] Open
Abstract
Background Disseminated germ cell cancers are at high risk of developing thromboembolic complications. We evaluated the prognostic value of venous thromboembolic events (VTE) in disseminated germ cell cancer. Methods Patients with germ cell cancer receiving upfront platinum-containing chemotherapy between 2004 and 2014 were pooled from the Spanish Germ Cell Cancer Group (SGCCG) registry and reviewed for the presence of VTE. Results were validated in an independent international group of patients. We used a penalized Cox proportional hazards model including VTE as a time-varying covariate to identify and validate prognostic factors. All statistical tests were two-sided. Results The SGCCG registry identified 416 patients from 14 referral institutions. With a median follow-up of 49 months, VTEs were observed in 9% of patients (n = 38). Events occurred at diagnosis, during chemotherapy, and after chemotherapy in 2.6%, 5.0%, and 1.4% of patients, respectively. VTE was associated with shorter progression-free survival (PFS; hazard ratio [HR] = 2.29, 95% confidence interval [CI] = 1.18 to 4.47, P = .02) and overall survival (OS; HR = 5.14, 95% CI = 2.22 to 11.88, P < .001). In multivariable analysis, the effect was consistent in the intermediate-risk group, both for PFS (HR = 9.52 95% CI = 2.48 to 36.58, P < .001) and OS (HR = 12.84, 95% CI = 2.01 to 82.02, P = .007). VTE at diagnosis is also an adverse prognostic variable for progression-free survival (HR = 4.64, 95% CI = 2.04 to 10.54, P < .001) and for overall survival (HR = 6.28, 95% CI = 1.68 to 17.10, P = .01). These results were validated in an independent international cohort that included 241 patients from four hospitals. Conclusions VTE is an independent adverse prognostic factor in disseminated germ cell cancers, in particular for the intermediate prognostic group of the International Germ Cell Cancer Collaborative Group classification. The presence of VTE at diagnosis has also prognostic significance and should be further explored in future prognostic classifications.
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Affiliation(s)
- Enrique Gonzalez-Billalabeitia
- Affiliations of authors: Hospital Universitario Morales Meseguer-IMIB, Murcia, Spain (EGB, MIL, ACB, FAdlP); Universidad Católica San Antonio de Murcia (UCAM), Murcia, Spain (EGB); Hospital Universitario 12 de Octubre, Madrid, Spain (DC, RM); Instituto Nacional de Cancerología, Mexico DF, Mexico (NS, JLA); Hospital San Joan de Reus, IISSPV, URV, Spain (JG); Instituto de Investigación Sanitaria La Fe, Valencia, Spain (DH); Hospital Universitario La Fe, Valencia, Spain (JA); Investigación Clínica y Traslacional en Cáncer/Instituto de Investigaciones Biomédicas de Málaga (IBIMA)/Hospitales Universitarios Regional y Virgen de la Victoria de Málaga, Málaga, Spain (ASM); Servicio de Oncología Médica, Hospital Clinic, IDIBAPS, Barcelona, Spain (BM); Hospital Clinico Lozano Blesa, Zaragoza, Spain (AS); Hospital Universitario Vall d'Hebron, Barcelona, Spain (CV); Complejo Hospitalario Universitario de Albacete, Albacete, Spain (AF); Institut Català d'Oncologia-Hospital Germans Trias i Pujol, Badalona, Spain (MM); Hospital Universitario Virgen del Rocío, Sevilla, Spain (ID); Hospital Central de Asturias, Oviedo, Spain (SF); Hospital Clínico San Carlos, Madrid, Spain (JS); Hospital Virgen de la Arrixaca, Murcia, Spain (SRo); Hospital de la Santa Creu i Sant Pau, Barcelona, Spain (PM); Hospital Santa Lucía, Cartagena, Spain (PC); Hospital de Oncología, Centro Médico Nacional SXXI, México DF, México (SRi); Institut Catala d'Oncologia, Barcelona, Spain (XGdM, JRGL)
| | - Daniel Castellano
- Affiliations of authors: Hospital Universitario Morales Meseguer-IMIB, Murcia, Spain (EGB, MIL, ACB, FAdlP); Universidad Católica San Antonio de Murcia (UCAM), Murcia, Spain (EGB); Hospital Universitario 12 de Octubre, Madrid, Spain (DC, RM); Instituto Nacional de Cancerología, Mexico DF, Mexico (NS, JLA); Hospital San Joan de Reus, IISSPV, URV, Spain (JG); Instituto de Investigación Sanitaria La Fe, Valencia, Spain (DH); Hospital Universitario La Fe, Valencia, Spain (JA); Investigación Clínica y Traslacional en Cáncer/Instituto de Investigaciones Biomédicas de Málaga (IBIMA)/Hospitales Universitarios Regional y Virgen de la Victoria de Málaga, Málaga, Spain (ASM); Servicio de Oncología Médica, Hospital Clinic, IDIBAPS, Barcelona, Spain (BM); Hospital Clinico Lozano Blesa, Zaragoza, Spain (AS); Hospital Universitario Vall d'Hebron, Barcelona, Spain (CV); Complejo Hospitalario Universitario de Albacete, Albacete, Spain (AF); Institut Català d'Oncologia-Hospital Germans Trias i Pujol, Badalona, Spain (MM); Hospital Universitario Virgen del Rocío, Sevilla, Spain (ID); Hospital Central de Asturias, Oviedo, Spain (SF); Hospital Clínico San Carlos, Madrid, Spain (JS); Hospital Virgen de la Arrixaca, Murcia, Spain (SRo); Hospital de la Santa Creu i Sant Pau, Barcelona, Spain (PM); Hospital Santa Lucía, Cartagena, Spain (PC); Hospital de Oncología, Centro Médico Nacional SXXI, México DF, México (SRi); Institut Catala d'Oncologia, Barcelona, Spain (XGdM, JRGL)
| | - Nora Sobrevilla
- Affiliations of authors: Hospital Universitario Morales Meseguer-IMIB, Murcia, Spain (EGB, MIL, ACB, FAdlP); Universidad Católica San Antonio de Murcia (UCAM), Murcia, Spain (EGB); Hospital Universitario 12 de Octubre, Madrid, Spain (DC, RM); Instituto Nacional de Cancerología, Mexico DF, Mexico (NS, JLA); Hospital San Joan de Reus, IISSPV, URV, Spain (JG); Instituto de Investigación Sanitaria La Fe, Valencia, Spain (DH); Hospital Universitario La Fe, Valencia, Spain (JA); Investigación Clínica y Traslacional en Cáncer/Instituto de Investigaciones Biomédicas de Málaga (IBIMA)/Hospitales Universitarios Regional y Virgen de la Victoria de Málaga, Málaga, Spain (ASM); Servicio de Oncología Médica, Hospital Clinic, IDIBAPS, Barcelona, Spain (BM); Hospital Clinico Lozano Blesa, Zaragoza, Spain (AS); Hospital Universitario Vall d'Hebron, Barcelona, Spain (CV); Complejo Hospitalario Universitario de Albacete, Albacete, Spain (AF); Institut Català d'Oncologia-Hospital Germans Trias i Pujol, Badalona, Spain (MM); Hospital Universitario Virgen del Rocío, Sevilla, Spain (ID); Hospital Central de Asturias, Oviedo, Spain (SF); Hospital Clínico San Carlos, Madrid, Spain (JS); Hospital Virgen de la Arrixaca, Murcia, Spain (SRo); Hospital de la Santa Creu i Sant Pau, Barcelona, Spain (PM); Hospital Santa Lucía, Cartagena, Spain (PC); Hospital de Oncología, Centro Médico Nacional SXXI, México DF, México (SRi); Institut Catala d'Oncologia, Barcelona, Spain (XGdM, JRGL)
| | - Josep Guma
- Affiliations of authors: Hospital Universitario Morales Meseguer-IMIB, Murcia, Spain (EGB, MIL, ACB, FAdlP); Universidad Católica San Antonio de Murcia (UCAM), Murcia, Spain (EGB); Hospital Universitario 12 de Octubre, Madrid, Spain (DC, RM); Instituto Nacional de Cancerología, Mexico DF, Mexico (NS, JLA); Hospital San Joan de Reus, IISSPV, URV, Spain (JG); Instituto de Investigación Sanitaria La Fe, Valencia, Spain (DH); Hospital Universitario La Fe, Valencia, Spain (JA); Investigación Clínica y Traslacional en Cáncer/Instituto de Investigaciones Biomédicas de Málaga (IBIMA)/Hospitales Universitarios Regional y Virgen de la Victoria de Málaga, Málaga, Spain (ASM); Servicio de Oncología Médica, Hospital Clinic, IDIBAPS, Barcelona, Spain (BM); Hospital Clinico Lozano Blesa, Zaragoza, Spain (AS); Hospital Universitario Vall d'Hebron, Barcelona, Spain (CV); Complejo Hospitalario Universitario de Albacete, Albacete, Spain (AF); Institut Català d'Oncologia-Hospital Germans Trias i Pujol, Badalona, Spain (MM); Hospital Universitario Virgen del Rocío, Sevilla, Spain (ID); Hospital Central de Asturias, Oviedo, Spain (SF); Hospital Clínico San Carlos, Madrid, Spain (JS); Hospital Virgen de la Arrixaca, Murcia, Spain (SRo); Hospital de la Santa Creu i Sant Pau, Barcelona, Spain (PM); Hospital Santa Lucía, Cartagena, Spain (PC); Hospital de Oncología, Centro Médico Nacional SXXI, México DF, México (SRi); Institut Catala d'Oncologia, Barcelona, Spain (XGdM, JRGL)
| | - David Hervas
- Affiliations of authors: Hospital Universitario Morales Meseguer-IMIB, Murcia, Spain (EGB, MIL, ACB, FAdlP); Universidad Católica San Antonio de Murcia (UCAM), Murcia, Spain (EGB); Hospital Universitario 12 de Octubre, Madrid, Spain (DC, RM); Instituto Nacional de Cancerología, Mexico DF, Mexico (NS, JLA); Hospital San Joan de Reus, IISSPV, URV, Spain (JG); Instituto de Investigación Sanitaria La Fe, Valencia, Spain (DH); Hospital Universitario La Fe, Valencia, Spain (JA); Investigación Clínica y Traslacional en Cáncer/Instituto de Investigaciones Biomédicas de Málaga (IBIMA)/Hospitales Universitarios Regional y Virgen de la Victoria de Málaga, Málaga, Spain (ASM); Servicio de Oncología Médica, Hospital Clinic, IDIBAPS, Barcelona, Spain (BM); Hospital Clinico Lozano Blesa, Zaragoza, Spain (AS); Hospital Universitario Vall d'Hebron, Barcelona, Spain (CV); Complejo Hospitalario Universitario de Albacete, Albacete, Spain (AF); Institut Català d'Oncologia-Hospital Germans Trias i Pujol, Badalona, Spain (MM); Hospital Universitario Virgen del Rocío, Sevilla, Spain (ID); Hospital Central de Asturias, Oviedo, Spain (SF); Hospital Clínico San Carlos, Madrid, Spain (JS); Hospital Virgen de la Arrixaca, Murcia, Spain (SRo); Hospital de la Santa Creu i Sant Pau, Barcelona, Spain (PM); Hospital Santa Lucía, Cartagena, Spain (PC); Hospital de Oncología, Centro Médico Nacional SXXI, México DF, México (SRi); Institut Catala d'Oncologia, Barcelona, Spain (XGdM, JRGL)
| | - Maria I Luengo
- Affiliations of authors: Hospital Universitario Morales Meseguer-IMIB, Murcia, Spain (EGB, MIL, ACB, FAdlP); Universidad Católica San Antonio de Murcia (UCAM), Murcia, Spain (EGB); Hospital Universitario 12 de Octubre, Madrid, Spain (DC, RM); Instituto Nacional de Cancerología, Mexico DF, Mexico (NS, JLA); Hospital San Joan de Reus, IISSPV, URV, Spain (JG); Instituto de Investigación Sanitaria La Fe, Valencia, Spain (DH); Hospital Universitario La Fe, Valencia, Spain (JA); Investigación Clínica y Traslacional en Cáncer/Instituto de Investigaciones Biomédicas de Málaga (IBIMA)/Hospitales Universitarios Regional y Virgen de la Victoria de Málaga, Málaga, Spain (ASM); Servicio de Oncología Médica, Hospital Clinic, IDIBAPS, Barcelona, Spain (BM); Hospital Clinico Lozano Blesa, Zaragoza, Spain (AS); Hospital Universitario Vall d'Hebron, Barcelona, Spain (CV); Complejo Hospitalario Universitario de Albacete, Albacete, Spain (AF); Institut Català d'Oncologia-Hospital Germans Trias i Pujol, Badalona, Spain (MM); Hospital Universitario Virgen del Rocío, Sevilla, Spain (ID); Hospital Central de Asturias, Oviedo, Spain (SF); Hospital Clínico San Carlos, Madrid, Spain (JS); Hospital Virgen de la Arrixaca, Murcia, Spain (SRo); Hospital de la Santa Creu i Sant Pau, Barcelona, Spain (PM); Hospital Santa Lucía, Cartagena, Spain (PC); Hospital de Oncología, Centro Médico Nacional SXXI, México DF, México (SRi); Institut Catala d'Oncologia, Barcelona, Spain (XGdM, JRGL)
| | - Jorge Aparicio
- Affiliations of authors: Hospital Universitario Morales Meseguer-IMIB, Murcia, Spain (EGB, MIL, ACB, FAdlP); Universidad Católica San Antonio de Murcia (UCAM), Murcia, Spain (EGB); Hospital Universitario 12 de Octubre, Madrid, Spain (DC, RM); Instituto Nacional de Cancerología, Mexico DF, Mexico (NS, JLA); Hospital San Joan de Reus, IISSPV, URV, Spain (JG); Instituto de Investigación Sanitaria La Fe, Valencia, Spain (DH); Hospital Universitario La Fe, Valencia, Spain (JA); Investigación Clínica y Traslacional en Cáncer/Instituto de Investigaciones Biomédicas de Málaga (IBIMA)/Hospitales Universitarios Regional y Virgen de la Victoria de Málaga, Málaga, Spain (ASM); Servicio de Oncología Médica, Hospital Clinic, IDIBAPS, Barcelona, Spain (BM); Hospital Clinico Lozano Blesa, Zaragoza, Spain (AS); Hospital Universitario Vall d'Hebron, Barcelona, Spain (CV); Complejo Hospitalario Universitario de Albacete, Albacete, Spain (AF); Institut Català d'Oncologia-Hospital Germans Trias i Pujol, Badalona, Spain (MM); Hospital Universitario Virgen del Rocío, Sevilla, Spain (ID); Hospital Central de Asturias, Oviedo, Spain (SF); Hospital Clínico San Carlos, Madrid, Spain (JS); Hospital Virgen de la Arrixaca, Murcia, Spain (SRo); Hospital de la Santa Creu i Sant Pau, Barcelona, Spain (PM); Hospital Santa Lucía, Cartagena, Spain (PC); Hospital de Oncología, Centro Médico Nacional SXXI, México DF, México (SRi); Institut Catala d'Oncologia, Barcelona, Spain (XGdM, JRGL)
| | - Alfonso Sanchez-Muñoz
- Affiliations of authors: Hospital Universitario Morales Meseguer-IMIB, Murcia, Spain (EGB, MIL, ACB, FAdlP); Universidad Católica San Antonio de Murcia (UCAM), Murcia, Spain (EGB); Hospital Universitario 12 de Octubre, Madrid, Spain (DC, RM); Instituto Nacional de Cancerología, Mexico DF, Mexico (NS, JLA); Hospital San Joan de Reus, IISSPV, URV, Spain (JG); Instituto de Investigación Sanitaria La Fe, Valencia, Spain (DH); Hospital Universitario La Fe, Valencia, Spain (JA); Investigación Clínica y Traslacional en Cáncer/Instituto de Investigaciones Biomédicas de Málaga (IBIMA)/Hospitales Universitarios Regional y Virgen de la Victoria de Málaga, Málaga, Spain (ASM); Servicio de Oncología Médica, Hospital Clinic, IDIBAPS, Barcelona, Spain (BM); Hospital Clinico Lozano Blesa, Zaragoza, Spain (AS); Hospital Universitario Vall d'Hebron, Barcelona, Spain (CV); Complejo Hospitalario Universitario de Albacete, Albacete, Spain (AF); Institut Català d'Oncologia-Hospital Germans Trias i Pujol, Badalona, Spain (MM); Hospital Universitario Virgen del Rocío, Sevilla, Spain (ID); Hospital Central de Asturias, Oviedo, Spain (SF); Hospital Clínico San Carlos, Madrid, Spain (JS); Hospital Virgen de la Arrixaca, Murcia, Spain (SRo); Hospital de la Santa Creu i Sant Pau, Barcelona, Spain (PM); Hospital Santa Lucía, Cartagena, Spain (PC); Hospital de Oncología, Centro Médico Nacional SXXI, México DF, México (SRi); Institut Catala d'Oncologia, Barcelona, Spain (XGdM, JRGL)
| | - Begoña Mellado
- Affiliations of authors: Hospital Universitario Morales Meseguer-IMIB, Murcia, Spain (EGB, MIL, ACB, FAdlP); Universidad Católica San Antonio de Murcia (UCAM), Murcia, Spain (EGB); Hospital Universitario 12 de Octubre, Madrid, Spain (DC, RM); Instituto Nacional de Cancerología, Mexico DF, Mexico (NS, JLA); Hospital San Joan de Reus, IISSPV, URV, Spain (JG); Instituto de Investigación Sanitaria La Fe, Valencia, Spain (DH); Hospital Universitario La Fe, Valencia, Spain (JA); Investigación Clínica y Traslacional en Cáncer/Instituto de Investigaciones Biomédicas de Málaga (IBIMA)/Hospitales Universitarios Regional y Virgen de la Victoria de Málaga, Málaga, Spain (ASM); Servicio de Oncología Médica, Hospital Clinic, IDIBAPS, Barcelona, Spain (BM); Hospital Clinico Lozano Blesa, Zaragoza, Spain (AS); Hospital Universitario Vall d'Hebron, Barcelona, Spain (CV); Complejo Hospitalario Universitario de Albacete, Albacete, Spain (AF); Institut Català d'Oncologia-Hospital Germans Trias i Pujol, Badalona, Spain (MM); Hospital Universitario Virgen del Rocío, Sevilla, Spain (ID); Hospital Central de Asturias, Oviedo, Spain (SF); Hospital Clínico San Carlos, Madrid, Spain (JS); Hospital Virgen de la Arrixaca, Murcia, Spain (SRo); Hospital de la Santa Creu i Sant Pau, Barcelona, Spain (PM); Hospital Santa Lucía, Cartagena, Spain (PC); Hospital de Oncología, Centro Médico Nacional SXXI, México DF, México (SRi); Institut Catala d'Oncologia, Barcelona, Spain (XGdM, JRGL)
| | - Alberto Saenz
- Affiliations of authors: Hospital Universitario Morales Meseguer-IMIB, Murcia, Spain (EGB, MIL, ACB, FAdlP); Universidad Católica San Antonio de Murcia (UCAM), Murcia, Spain (EGB); Hospital Universitario 12 de Octubre, Madrid, Spain (DC, RM); Instituto Nacional de Cancerología, Mexico DF, Mexico (NS, JLA); Hospital San Joan de Reus, IISSPV, URV, Spain (JG); Instituto de Investigación Sanitaria La Fe, Valencia, Spain (DH); Hospital Universitario La Fe, Valencia, Spain (JA); Investigación Clínica y Traslacional en Cáncer/Instituto de Investigaciones Biomédicas de Málaga (IBIMA)/Hospitales Universitarios Regional y Virgen de la Victoria de Málaga, Málaga, Spain (ASM); Servicio de Oncología Médica, Hospital Clinic, IDIBAPS, Barcelona, Spain (BM); Hospital Clinico Lozano Blesa, Zaragoza, Spain (AS); Hospital Universitario Vall d'Hebron, Barcelona, Spain (CV); Complejo Hospitalario Universitario de Albacete, Albacete, Spain (AF); Institut Català d'Oncologia-Hospital Germans Trias i Pujol, Badalona, Spain (MM); Hospital Universitario Virgen del Rocío, Sevilla, Spain (ID); Hospital Central de Asturias, Oviedo, Spain (SF); Hospital Clínico San Carlos, Madrid, Spain (JS); Hospital Virgen de la Arrixaca, Murcia, Spain (SRo); Hospital de la Santa Creu i Sant Pau, Barcelona, Spain (PM); Hospital Santa Lucía, Cartagena, Spain (PC); Hospital de Oncología, Centro Médico Nacional SXXI, México DF, México (SRi); Institut Catala d'Oncologia, Barcelona, Spain (XGdM, JRGL)
| | - Claudia Valverde
- Affiliations of authors: Hospital Universitario Morales Meseguer-IMIB, Murcia, Spain (EGB, MIL, ACB, FAdlP); Universidad Católica San Antonio de Murcia (UCAM), Murcia, Spain (EGB); Hospital Universitario 12 de Octubre, Madrid, Spain (DC, RM); Instituto Nacional de Cancerología, Mexico DF, Mexico (NS, JLA); Hospital San Joan de Reus, IISSPV, URV, Spain (JG); Instituto de Investigación Sanitaria La Fe, Valencia, Spain (DH); Hospital Universitario La Fe, Valencia, Spain (JA); Investigación Clínica y Traslacional en Cáncer/Instituto de Investigaciones Biomédicas de Málaga (IBIMA)/Hospitales Universitarios Regional y Virgen de la Victoria de Málaga, Málaga, Spain (ASM); Servicio de Oncología Médica, Hospital Clinic, IDIBAPS, Barcelona, Spain (BM); Hospital Clinico Lozano Blesa, Zaragoza, Spain (AS); Hospital Universitario Vall d'Hebron, Barcelona, Spain (CV); Complejo Hospitalario Universitario de Albacete, Albacete, Spain (AF); Institut Català d'Oncologia-Hospital Germans Trias i Pujol, Badalona, Spain (MM); Hospital Universitario Virgen del Rocío, Sevilla, Spain (ID); Hospital Central de Asturias, Oviedo, Spain (SF); Hospital Clínico San Carlos, Madrid, Spain (JS); Hospital Virgen de la Arrixaca, Murcia, Spain (SRo); Hospital de la Santa Creu i Sant Pau, Barcelona, Spain (PM); Hospital Santa Lucía, Cartagena, Spain (PC); Hospital de Oncología, Centro Médico Nacional SXXI, México DF, México (SRi); Institut Catala d'Oncologia, Barcelona, Spain (XGdM, JRGL)
| | - Antonio Fernandez
- Affiliations of authors: Hospital Universitario Morales Meseguer-IMIB, Murcia, Spain (EGB, MIL, ACB, FAdlP); Universidad Católica San Antonio de Murcia (UCAM), Murcia, Spain (EGB); Hospital Universitario 12 de Octubre, Madrid, Spain (DC, RM); Instituto Nacional de Cancerología, Mexico DF, Mexico (NS, JLA); Hospital San Joan de Reus, IISSPV, URV, Spain (JG); Instituto de Investigación Sanitaria La Fe, Valencia, Spain (DH); Hospital Universitario La Fe, Valencia, Spain (JA); Investigación Clínica y Traslacional en Cáncer/Instituto de Investigaciones Biomédicas de Málaga (IBIMA)/Hospitales Universitarios Regional y Virgen de la Victoria de Málaga, Málaga, Spain (ASM); Servicio de Oncología Médica, Hospital Clinic, IDIBAPS, Barcelona, Spain (BM); Hospital Clinico Lozano Blesa, Zaragoza, Spain (AS); Hospital Universitario Vall d'Hebron, Barcelona, Spain (CV); Complejo Hospitalario Universitario de Albacete, Albacete, Spain (AF); Institut Català d'Oncologia-Hospital Germans Trias i Pujol, Badalona, Spain (MM); Hospital Universitario Virgen del Rocío, Sevilla, Spain (ID); Hospital Central de Asturias, Oviedo, Spain (SF); Hospital Clínico San Carlos, Madrid, Spain (JS); Hospital Virgen de la Arrixaca, Murcia, Spain (SRo); Hospital de la Santa Creu i Sant Pau, Barcelona, Spain (PM); Hospital Santa Lucía, Cartagena, Spain (PC); Hospital de Oncología, Centro Médico Nacional SXXI, México DF, México (SRi); Institut Catala d'Oncologia, Barcelona, Spain (XGdM, JRGL)
| | - Mireia Margeli
- Affiliations of authors: Hospital Universitario Morales Meseguer-IMIB, Murcia, Spain (EGB, MIL, ACB, FAdlP); Universidad Católica San Antonio de Murcia (UCAM), Murcia, Spain (EGB); Hospital Universitario 12 de Octubre, Madrid, Spain (DC, RM); Instituto Nacional de Cancerología, Mexico DF, Mexico (NS, JLA); Hospital San Joan de Reus, IISSPV, URV, Spain (JG); Instituto de Investigación Sanitaria La Fe, Valencia, Spain (DH); Hospital Universitario La Fe, Valencia, Spain (JA); Investigación Clínica y Traslacional en Cáncer/Instituto de Investigaciones Biomédicas de Málaga (IBIMA)/Hospitales Universitarios Regional y Virgen de la Victoria de Málaga, Málaga, Spain (ASM); Servicio de Oncología Médica, Hospital Clinic, IDIBAPS, Barcelona, Spain (BM); Hospital Clinico Lozano Blesa, Zaragoza, Spain (AS); Hospital Universitario Vall d'Hebron, Barcelona, Spain (CV); Complejo Hospitalario Universitario de Albacete, Albacete, Spain (AF); Institut Català d'Oncologia-Hospital Germans Trias i Pujol, Badalona, Spain (MM); Hospital Universitario Virgen del Rocío, Sevilla, Spain (ID); Hospital Central de Asturias, Oviedo, Spain (SF); Hospital Clínico San Carlos, Madrid, Spain (JS); Hospital Virgen de la Arrixaca, Murcia, Spain (SRo); Hospital de la Santa Creu i Sant Pau, Barcelona, Spain (PM); Hospital Santa Lucía, Cartagena, Spain (PC); Hospital de Oncología, Centro Médico Nacional SXXI, México DF, México (SRi); Institut Catala d'Oncologia, Barcelona, Spain (XGdM, JRGL)
| | - Ignacio Duran
- Affiliations of authors: Hospital Universitario Morales Meseguer-IMIB, Murcia, Spain (EGB, MIL, ACB, FAdlP); Universidad Católica San Antonio de Murcia (UCAM), Murcia, Spain (EGB); Hospital Universitario 12 de Octubre, Madrid, Spain (DC, RM); Instituto Nacional de Cancerología, Mexico DF, Mexico (NS, JLA); Hospital San Joan de Reus, IISSPV, URV, Spain (JG); Instituto de Investigación Sanitaria La Fe, Valencia, Spain (DH); Hospital Universitario La Fe, Valencia, Spain (JA); Investigación Clínica y Traslacional en Cáncer/Instituto de Investigaciones Biomédicas de Málaga (IBIMA)/Hospitales Universitarios Regional y Virgen de la Victoria de Málaga, Málaga, Spain (ASM); Servicio de Oncología Médica, Hospital Clinic, IDIBAPS, Barcelona, Spain (BM); Hospital Clinico Lozano Blesa, Zaragoza, Spain (AS); Hospital Universitario Vall d'Hebron, Barcelona, Spain (CV); Complejo Hospitalario Universitario de Albacete, Albacete, Spain (AF); Institut Català d'Oncologia-Hospital Germans Trias i Pujol, Badalona, Spain (MM); Hospital Universitario Virgen del Rocío, Sevilla, Spain (ID); Hospital Central de Asturias, Oviedo, Spain (SF); Hospital Clínico San Carlos, Madrid, Spain (JS); Hospital Virgen de la Arrixaca, Murcia, Spain (SRo); Hospital de la Santa Creu i Sant Pau, Barcelona, Spain (PM); Hospital Santa Lucía, Cartagena, Spain (PC); Hospital de Oncología, Centro Médico Nacional SXXI, México DF, México (SRi); Institut Catala d'Oncologia, Barcelona, Spain (XGdM, JRGL)
| | - Sara Fernandez
- Affiliations of authors: Hospital Universitario Morales Meseguer-IMIB, Murcia, Spain (EGB, MIL, ACB, FAdlP); Universidad Católica San Antonio de Murcia (UCAM), Murcia, Spain (EGB); Hospital Universitario 12 de Octubre, Madrid, Spain (DC, RM); Instituto Nacional de Cancerología, Mexico DF, Mexico (NS, JLA); Hospital San Joan de Reus, IISSPV, URV, Spain (JG); Instituto de Investigación Sanitaria La Fe, Valencia, Spain (DH); Hospital Universitario La Fe, Valencia, Spain (JA); Investigación Clínica y Traslacional en Cáncer/Instituto de Investigaciones Biomédicas de Málaga (IBIMA)/Hospitales Universitarios Regional y Virgen de la Victoria de Málaga, Málaga, Spain (ASM); Servicio de Oncología Médica, Hospital Clinic, IDIBAPS, Barcelona, Spain (BM); Hospital Clinico Lozano Blesa, Zaragoza, Spain (AS); Hospital Universitario Vall d'Hebron, Barcelona, Spain (CV); Complejo Hospitalario Universitario de Albacete, Albacete, Spain (AF); Institut Català d'Oncologia-Hospital Germans Trias i Pujol, Badalona, Spain (MM); Hospital Universitario Virgen del Rocío, Sevilla, Spain (ID); Hospital Central de Asturias, Oviedo, Spain (SF); Hospital Clínico San Carlos, Madrid, Spain (JS); Hospital Virgen de la Arrixaca, Murcia, Spain (SRo); Hospital de la Santa Creu i Sant Pau, Barcelona, Spain (PM); Hospital Santa Lucía, Cartagena, Spain (PC); Hospital de Oncología, Centro Médico Nacional SXXI, México DF, México (SRi); Institut Catala d'Oncologia, Barcelona, Spain (XGdM, JRGL)
| | - Javier Sastre
- Affiliations of authors: Hospital Universitario Morales Meseguer-IMIB, Murcia, Spain (EGB, MIL, ACB, FAdlP); Universidad Católica San Antonio de Murcia (UCAM), Murcia, Spain (EGB); Hospital Universitario 12 de Octubre, Madrid, Spain (DC, RM); Instituto Nacional de Cancerología, Mexico DF, Mexico (NS, JLA); Hospital San Joan de Reus, IISSPV, URV, Spain (JG); Instituto de Investigación Sanitaria La Fe, Valencia, Spain (DH); Hospital Universitario La Fe, Valencia, Spain (JA); Investigación Clínica y Traslacional en Cáncer/Instituto de Investigaciones Biomédicas de Málaga (IBIMA)/Hospitales Universitarios Regional y Virgen de la Victoria de Málaga, Málaga, Spain (ASM); Servicio de Oncología Médica, Hospital Clinic, IDIBAPS, Barcelona, Spain (BM); Hospital Clinico Lozano Blesa, Zaragoza, Spain (AS); Hospital Universitario Vall d'Hebron, Barcelona, Spain (CV); Complejo Hospitalario Universitario de Albacete, Albacete, Spain (AF); Institut Català d'Oncologia-Hospital Germans Trias i Pujol, Badalona, Spain (MM); Hospital Universitario Virgen del Rocío, Sevilla, Spain (ID); Hospital Central de Asturias, Oviedo, Spain (SF); Hospital Clínico San Carlos, Madrid, Spain (JS); Hospital Virgen de la Arrixaca, Murcia, Spain (SRo); Hospital de la Santa Creu i Sant Pau, Barcelona, Spain (PM); Hospital Santa Lucía, Cartagena, Spain (PC); Hospital de Oncología, Centro Médico Nacional SXXI, México DF, México (SRi); Institut Catala d'Oncologia, Barcelona, Spain (XGdM, JRGL)
| | - Silverio Ros
- Affiliations of authors: Hospital Universitario Morales Meseguer-IMIB, Murcia, Spain (EGB, MIL, ACB, FAdlP); Universidad Católica San Antonio de Murcia (UCAM), Murcia, Spain (EGB); Hospital Universitario 12 de Octubre, Madrid, Spain (DC, RM); Instituto Nacional de Cancerología, Mexico DF, Mexico (NS, JLA); Hospital San Joan de Reus, IISSPV, URV, Spain (JG); Instituto de Investigación Sanitaria La Fe, Valencia, Spain (DH); Hospital Universitario La Fe, Valencia, Spain (JA); Investigación Clínica y Traslacional en Cáncer/Instituto de Investigaciones Biomédicas de Málaga (IBIMA)/Hospitales Universitarios Regional y Virgen de la Victoria de Málaga, Málaga, Spain (ASM); Servicio de Oncología Médica, Hospital Clinic, IDIBAPS, Barcelona, Spain (BM); Hospital Clinico Lozano Blesa, Zaragoza, Spain (AS); Hospital Universitario Vall d'Hebron, Barcelona, Spain (CV); Complejo Hospitalario Universitario de Albacete, Albacete, Spain (AF); Institut Català d'Oncologia-Hospital Germans Trias i Pujol, Badalona, Spain (MM); Hospital Universitario Virgen del Rocío, Sevilla, Spain (ID); Hospital Central de Asturias, Oviedo, Spain (SF); Hospital Clínico San Carlos, Madrid, Spain (JS); Hospital Virgen de la Arrixaca, Murcia, Spain (SRo); Hospital de la Santa Creu i Sant Pau, Barcelona, Spain (PM); Hospital Santa Lucía, Cartagena, Spain (PC); Hospital de Oncología, Centro Médico Nacional SXXI, México DF, México (SRi); Institut Catala d'Oncologia, Barcelona, Spain (XGdM, JRGL)
| | - Pablo Maroto
- Affiliations of authors: Hospital Universitario Morales Meseguer-IMIB, Murcia, Spain (EGB, MIL, ACB, FAdlP); Universidad Católica San Antonio de Murcia (UCAM), Murcia, Spain (EGB); Hospital Universitario 12 de Octubre, Madrid, Spain (DC, RM); Instituto Nacional de Cancerología, Mexico DF, Mexico (NS, JLA); Hospital San Joan de Reus, IISSPV, URV, Spain (JG); Instituto de Investigación Sanitaria La Fe, Valencia, Spain (DH); Hospital Universitario La Fe, Valencia, Spain (JA); Investigación Clínica y Traslacional en Cáncer/Instituto de Investigaciones Biomédicas de Málaga (IBIMA)/Hospitales Universitarios Regional y Virgen de la Victoria de Málaga, Málaga, Spain (ASM); Servicio de Oncología Médica, Hospital Clinic, IDIBAPS, Barcelona, Spain (BM); Hospital Clinico Lozano Blesa, Zaragoza, Spain (AS); Hospital Universitario Vall d'Hebron, Barcelona, Spain (CV); Complejo Hospitalario Universitario de Albacete, Albacete, Spain (AF); Institut Català d'Oncologia-Hospital Germans Trias i Pujol, Badalona, Spain (MM); Hospital Universitario Virgen del Rocío, Sevilla, Spain (ID); Hospital Central de Asturias, Oviedo, Spain (SF); Hospital Clínico San Carlos, Madrid, Spain (JS); Hospital Virgen de la Arrixaca, Murcia, Spain (SRo); Hospital de la Santa Creu i Sant Pau, Barcelona, Spain (PM); Hospital Santa Lucía, Cartagena, Spain (PC); Hospital de Oncología, Centro Médico Nacional SXXI, México DF, México (SRi); Institut Catala d'Oncologia, Barcelona, Spain (XGdM, JRGL)
| | - Ray Manneh
- Affiliations of authors: Hospital Universitario Morales Meseguer-IMIB, Murcia, Spain (EGB, MIL, ACB, FAdlP); Universidad Católica San Antonio de Murcia (UCAM), Murcia, Spain (EGB); Hospital Universitario 12 de Octubre, Madrid, Spain (DC, RM); Instituto Nacional de Cancerología, Mexico DF, Mexico (NS, JLA); Hospital San Joan de Reus, IISSPV, URV, Spain (JG); Instituto de Investigación Sanitaria La Fe, Valencia, Spain (DH); Hospital Universitario La Fe, Valencia, Spain (JA); Investigación Clínica y Traslacional en Cáncer/Instituto de Investigaciones Biomédicas de Málaga (IBIMA)/Hospitales Universitarios Regional y Virgen de la Victoria de Málaga, Málaga, Spain (ASM); Servicio de Oncología Médica, Hospital Clinic, IDIBAPS, Barcelona, Spain (BM); Hospital Clinico Lozano Blesa, Zaragoza, Spain (AS); Hospital Universitario Vall d'Hebron, Barcelona, Spain (CV); Complejo Hospitalario Universitario de Albacete, Albacete, Spain (AF); Institut Català d'Oncologia-Hospital Germans Trias i Pujol, Badalona, Spain (MM); Hospital Universitario Virgen del Rocío, Sevilla, Spain (ID); Hospital Central de Asturias, Oviedo, Spain (SF); Hospital Clínico San Carlos, Madrid, Spain (JS); Hospital Virgen de la Arrixaca, Murcia, Spain (SRo); Hospital de la Santa Creu i Sant Pau, Barcelona, Spain (PM); Hospital Santa Lucía, Cartagena, Spain (PC); Hospital de Oncología, Centro Médico Nacional SXXI, México DF, México (SRi); Institut Catala d'Oncologia, Barcelona, Spain (XGdM, JRGL)
| | - Pablo Cerezuela
- Affiliations of authors: Hospital Universitario Morales Meseguer-IMIB, Murcia, Spain (EGB, MIL, ACB, FAdlP); Universidad Católica San Antonio de Murcia (UCAM), Murcia, Spain (EGB); Hospital Universitario 12 de Octubre, Madrid, Spain (DC, RM); Instituto Nacional de Cancerología, Mexico DF, Mexico (NS, JLA); Hospital San Joan de Reus, IISSPV, URV, Spain (JG); Instituto de Investigación Sanitaria La Fe, Valencia, Spain (DH); Hospital Universitario La Fe, Valencia, Spain (JA); Investigación Clínica y Traslacional en Cáncer/Instituto de Investigaciones Biomédicas de Málaga (IBIMA)/Hospitales Universitarios Regional y Virgen de la Victoria de Málaga, Málaga, Spain (ASM); Servicio de Oncología Médica, Hospital Clinic, IDIBAPS, Barcelona, Spain (BM); Hospital Clinico Lozano Blesa, Zaragoza, Spain (AS); Hospital Universitario Vall d'Hebron, Barcelona, Spain (CV); Complejo Hospitalario Universitario de Albacete, Albacete, Spain (AF); Institut Català d'Oncologia-Hospital Germans Trias i Pujol, Badalona, Spain (MM); Hospital Universitario Virgen del Rocío, Sevilla, Spain (ID); Hospital Central de Asturias, Oviedo, Spain (SF); Hospital Clínico San Carlos, Madrid, Spain (JS); Hospital Virgen de la Arrixaca, Murcia, Spain (SRo); Hospital de la Santa Creu i Sant Pau, Barcelona, Spain (PM); Hospital Santa Lucía, Cartagena, Spain (PC); Hospital de Oncología, Centro Médico Nacional SXXI, México DF, México (SRi); Institut Catala d'Oncologia, Barcelona, Spain (XGdM, JRGL)
| | - Alberto Carmona-Bayonas
- Affiliations of authors: Hospital Universitario Morales Meseguer-IMIB, Murcia, Spain (EGB, MIL, ACB, FAdlP); Universidad Católica San Antonio de Murcia (UCAM), Murcia, Spain (EGB); Hospital Universitario 12 de Octubre, Madrid, Spain (DC, RM); Instituto Nacional de Cancerología, Mexico DF, Mexico (NS, JLA); Hospital San Joan de Reus, IISSPV, URV, Spain (JG); Instituto de Investigación Sanitaria La Fe, Valencia, Spain (DH); Hospital Universitario La Fe, Valencia, Spain (JA); Investigación Clínica y Traslacional en Cáncer/Instituto de Investigaciones Biomédicas de Málaga (IBIMA)/Hospitales Universitarios Regional y Virgen de la Victoria de Málaga, Málaga, Spain (ASM); Servicio de Oncología Médica, Hospital Clinic, IDIBAPS, Barcelona, Spain (BM); Hospital Clinico Lozano Blesa, Zaragoza, Spain (AS); Hospital Universitario Vall d'Hebron, Barcelona, Spain (CV); Complejo Hospitalario Universitario de Albacete, Albacete, Spain (AF); Institut Català d'Oncologia-Hospital Germans Trias i Pujol, Badalona, Spain (MM); Hospital Universitario Virgen del Rocío, Sevilla, Spain (ID); Hospital Central de Asturias, Oviedo, Spain (SF); Hospital Clínico San Carlos, Madrid, Spain (JS); Hospital Virgen de la Arrixaca, Murcia, Spain (SRo); Hospital de la Santa Creu i Sant Pau, Barcelona, Spain (PM); Hospital Santa Lucía, Cartagena, Spain (PC); Hospital de Oncología, Centro Médico Nacional SXXI, México DF, México (SRi); Institut Catala d'Oncologia, Barcelona, Spain (XGdM, JRGL)
| | - Francisco Ayala de la Peña
- Affiliations of authors: Hospital Universitario Morales Meseguer-IMIB, Murcia, Spain (EGB, MIL, ACB, FAdlP); Universidad Católica San Antonio de Murcia (UCAM), Murcia, Spain (EGB); Hospital Universitario 12 de Octubre, Madrid, Spain (DC, RM); Instituto Nacional de Cancerología, Mexico DF, Mexico (NS, JLA); Hospital San Joan de Reus, IISSPV, URV, Spain (JG); Instituto de Investigación Sanitaria La Fe, Valencia, Spain (DH); Hospital Universitario La Fe, Valencia, Spain (JA); Investigación Clínica y Traslacional en Cáncer/Instituto de Investigaciones Biomédicas de Málaga (IBIMA)/Hospitales Universitarios Regional y Virgen de la Victoria de Málaga, Málaga, Spain (ASM); Servicio de Oncología Médica, Hospital Clinic, IDIBAPS, Barcelona, Spain (BM); Hospital Clinico Lozano Blesa, Zaragoza, Spain (AS); Hospital Universitario Vall d'Hebron, Barcelona, Spain (CV); Complejo Hospitalario Universitario de Albacete, Albacete, Spain (AF); Institut Català d'Oncologia-Hospital Germans Trias i Pujol, Badalona, Spain (MM); Hospital Universitario Virgen del Rocío, Sevilla, Spain (ID); Hospital Central de Asturias, Oviedo, Spain (SF); Hospital Clínico San Carlos, Madrid, Spain (JS); Hospital Virgen de la Arrixaca, Murcia, Spain (SRo); Hospital de la Santa Creu i Sant Pau, Barcelona, Spain (PM); Hospital Santa Lucía, Cartagena, Spain (PC); Hospital de Oncología, Centro Médico Nacional SXXI, México DF, México (SRi); Institut Catala d'Oncologia, Barcelona, Spain (XGdM, JRGL)
| | - Jose Luis Aguilar
- Affiliations of authors: Hospital Universitario Morales Meseguer-IMIB, Murcia, Spain (EGB, MIL, ACB, FAdlP); Universidad Católica San Antonio de Murcia (UCAM), Murcia, Spain (EGB); Hospital Universitario 12 de Octubre, Madrid, Spain (DC, RM); Instituto Nacional de Cancerología, Mexico DF, Mexico (NS, JLA); Hospital San Joan de Reus, IISSPV, URV, Spain (JG); Instituto de Investigación Sanitaria La Fe, Valencia, Spain (DH); Hospital Universitario La Fe, Valencia, Spain (JA); Investigación Clínica y Traslacional en Cáncer/Instituto de Investigaciones Biomédicas de Málaga (IBIMA)/Hospitales Universitarios Regional y Virgen de la Victoria de Málaga, Málaga, Spain (ASM); Servicio de Oncología Médica, Hospital Clinic, IDIBAPS, Barcelona, Spain (BM); Hospital Clinico Lozano Blesa, Zaragoza, Spain (AS); Hospital Universitario Vall d'Hebron, Barcelona, Spain (CV); Complejo Hospitalario Universitario de Albacete, Albacete, Spain (AF); Institut Català d'Oncologia-Hospital Germans Trias i Pujol, Badalona, Spain (MM); Hospital Universitario Virgen del Rocío, Sevilla, Spain (ID); Hospital Central de Asturias, Oviedo, Spain (SF); Hospital Clínico San Carlos, Madrid, Spain (JS); Hospital Virgen de la Arrixaca, Murcia, Spain (SRo); Hospital de la Santa Creu i Sant Pau, Barcelona, Spain (PM); Hospital Santa Lucía, Cartagena, Spain (PC); Hospital de Oncología, Centro Médico Nacional SXXI, México DF, México (SRi); Institut Catala d'Oncologia, Barcelona, Spain (XGdM, JRGL)
| | - Samuel Rivera
- Affiliations of authors: Hospital Universitario Morales Meseguer-IMIB, Murcia, Spain (EGB, MIL, ACB, FAdlP); Universidad Católica San Antonio de Murcia (UCAM), Murcia, Spain (EGB); Hospital Universitario 12 de Octubre, Madrid, Spain (DC, RM); Instituto Nacional de Cancerología, Mexico DF, Mexico (NS, JLA); Hospital San Joan de Reus, IISSPV, URV, Spain (JG); Instituto de Investigación Sanitaria La Fe, Valencia, Spain (DH); Hospital Universitario La Fe, Valencia, Spain (JA); Investigación Clínica y Traslacional en Cáncer/Instituto de Investigaciones Biomédicas de Málaga (IBIMA)/Hospitales Universitarios Regional y Virgen de la Victoria de Málaga, Málaga, Spain (ASM); Servicio de Oncología Médica, Hospital Clinic, IDIBAPS, Barcelona, Spain (BM); Hospital Clinico Lozano Blesa, Zaragoza, Spain (AS); Hospital Universitario Vall d'Hebron, Barcelona, Spain (CV); Complejo Hospitalario Universitario de Albacete, Albacete, Spain (AF); Institut Català d'Oncologia-Hospital Germans Trias i Pujol, Badalona, Spain (MM); Hospital Universitario Virgen del Rocío, Sevilla, Spain (ID); Hospital Central de Asturias, Oviedo, Spain (SF); Hospital Clínico San Carlos, Madrid, Spain (JS); Hospital Virgen de la Arrixaca, Murcia, Spain (SRo); Hospital de la Santa Creu i Sant Pau, Barcelona, Spain (PM); Hospital Santa Lucía, Cartagena, Spain (PC); Hospital de Oncología, Centro Médico Nacional SXXI, México DF, México (SRi); Institut Catala d'Oncologia, Barcelona, Spain (XGdM, JRGL)
| | - Xavier García Del Muro
- Affiliations of authors: Hospital Universitario Morales Meseguer-IMIB, Murcia, Spain (EGB, MIL, ACB, FAdlP); Universidad Católica San Antonio de Murcia (UCAM), Murcia, Spain (EGB); Hospital Universitario 12 de Octubre, Madrid, Spain (DC, RM); Instituto Nacional de Cancerología, Mexico DF, Mexico (NS, JLA); Hospital San Joan de Reus, IISSPV, URV, Spain (JG); Instituto de Investigación Sanitaria La Fe, Valencia, Spain (DH); Hospital Universitario La Fe, Valencia, Spain (JA); Investigación Clínica y Traslacional en Cáncer/Instituto de Investigaciones Biomédicas de Málaga (IBIMA)/Hospitales Universitarios Regional y Virgen de la Victoria de Málaga, Málaga, Spain (ASM); Servicio de Oncología Médica, Hospital Clinic, IDIBAPS, Barcelona, Spain (BM); Hospital Clinico Lozano Blesa, Zaragoza, Spain (AS); Hospital Universitario Vall d'Hebron, Barcelona, Spain (CV); Complejo Hospitalario Universitario de Albacete, Albacete, Spain (AF); Institut Català d'Oncologia-Hospital Germans Trias i Pujol, Badalona, Spain (MM); Hospital Universitario Virgen del Rocío, Sevilla, Spain (ID); Hospital Central de Asturias, Oviedo, Spain (SF); Hospital Clínico San Carlos, Madrid, Spain (JS); Hospital Virgen de la Arrixaca, Murcia, Spain (SRo); Hospital de la Santa Creu i Sant Pau, Barcelona, Spain (PM); Hospital Santa Lucía, Cartagena, Spain (PC); Hospital de Oncología, Centro Médico Nacional SXXI, México DF, México (SRi); Institut Catala d'Oncologia, Barcelona, Spain (XGdM, JRGL)
| | - Jose R Germà-Lluch
- Affiliations of authors: Hospital Universitario Morales Meseguer-IMIB, Murcia, Spain (EGB, MIL, ACB, FAdlP); Universidad Católica San Antonio de Murcia (UCAM), Murcia, Spain (EGB); Hospital Universitario 12 de Octubre, Madrid, Spain (DC, RM); Instituto Nacional de Cancerología, Mexico DF, Mexico (NS, JLA); Hospital San Joan de Reus, IISSPV, URV, Spain (JG); Instituto de Investigación Sanitaria La Fe, Valencia, Spain (DH); Hospital Universitario La Fe, Valencia, Spain (JA); Investigación Clínica y Traslacional en Cáncer/Instituto de Investigaciones Biomédicas de Málaga (IBIMA)/Hospitales Universitarios Regional y Virgen de la Victoria de Málaga, Málaga, Spain (ASM); Servicio de Oncología Médica, Hospital Clinic, IDIBAPS, Barcelona, Spain (BM); Hospital Clinico Lozano Blesa, Zaragoza, Spain (AS); Hospital Universitario Vall d'Hebron, Barcelona, Spain (CV); Complejo Hospitalario Universitario de Albacete, Albacete, Spain (AF); Institut Català d'Oncologia-Hospital Germans Trias i Pujol, Badalona, Spain (MM); Hospital Universitario Virgen del Rocío, Sevilla, Spain (ID); Hospital Central de Asturias, Oviedo, Spain (SF); Hospital Clínico San Carlos, Madrid, Spain (JS); Hospital Virgen de la Arrixaca, Murcia, Spain (SRo); Hospital de la Santa Creu i Sant Pau, Barcelona, Spain (PM); Hospital Santa Lucía, Cartagena, Spain (PC); Hospital de Oncología, Centro Médico Nacional SXXI, México DF, México (SRi); Institut Catala d'Oncologia, Barcelona, Spain (XGdM, JRGL)
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DeFilipp Z, Rosand CB, Goldstein DA, Master VA, Carthon BC, Harris WB, Kucuk O, Al-Kadhimi Z, Cohen JB, Flowers CR, Lechowicz MJ, Nooka AK, Kaufman JL, Langston AA, Chen Z, Arora J, Waller EK. Comparable outcomes following two or three cycles of high-dose chemotherapy and autologous stem cell transplantation for patients with relapsed/refractory germ cell tumors. Bone Marrow Transplant 2016; 52:132-134. [PMID: 27427922 DOI: 10.1038/bmt.2016.189] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Affiliation(s)
- Z DeFilipp
- Department of Hematology and Medical Oncology, Winship Cancer Institute of Emory University, Atlanta, GA, USA
| | - C B Rosand
- Department of Hematology and Medical Oncology, Winship Cancer Institute of Emory University, Atlanta, GA, USA
| | - D A Goldstein
- Department of Hematology and Medical Oncology, Winship Cancer Institute of Emory University, Atlanta, GA, USA
| | - V A Master
- Department of Urology, Emory University School of Medicine, Atlanta, GA, USA
| | - B C Carthon
- Department of Hematology and Medical Oncology, Winship Cancer Institute of Emory University, Atlanta, GA, USA
| | - W B Harris
- Department of Hematology and Medical Oncology, Winship Cancer Institute of Emory University, Atlanta, GA, USA
| | - O Kucuk
- Department of Hematology and Medical Oncology, Winship Cancer Institute of Emory University, Atlanta, GA, USA
| | - Z Al-Kadhimi
- Department of Hematology and Medical Oncology, Winship Cancer Institute of Emory University, Atlanta, GA, USA
| | - J B Cohen
- Department of Hematology and Medical Oncology, Winship Cancer Institute of Emory University, Atlanta, GA, USA
| | - C R Flowers
- Department of Hematology and Medical Oncology, Winship Cancer Institute of Emory University, Atlanta, GA, USA
| | - M J Lechowicz
- Department of Hematology and Medical Oncology, Winship Cancer Institute of Emory University, Atlanta, GA, USA
| | - A K Nooka
- Department of Hematology and Medical Oncology, Winship Cancer Institute of Emory University, Atlanta, GA, USA
| | - J L Kaufman
- Department of Hematology and Medical Oncology, Winship Cancer Institute of Emory University, Atlanta, GA, USA
| | - A A Langston
- Department of Hematology and Medical Oncology, Winship Cancer Institute of Emory University, Atlanta, GA, USA
| | - Z Chen
- Department of Biostatistics and Bioinformatics, Emory University School of Public Health, Atlanta, GA, USA
| | - J Arora
- Department of Biostatistics and Bioinformatics, Emory University School of Public Health, Atlanta, GA, USA
| | - E K Waller
- Department of Hematology and Medical Oncology, Winship Cancer Institute of Emory University, Atlanta, GA, USA
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30
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de la Motte Rouge T, Pautier P, Genestie C, Rey A, Gouy S, Leary A, Haie-Meder C, Kerbrat P, Culine S, Fizazi K, Lhommé C. Prognostic significance of an early decline in serum alpha-fetoprotein during chemotherapy for ovarian yolk sac tumors. Gynecol Oncol 2016; 142:452-7. [PMID: 27401840 DOI: 10.1016/j.ygyno.2016.07.005] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2016] [Revised: 07/02/2016] [Accepted: 07/04/2016] [Indexed: 10/21/2022]
Abstract
BACKGROUND The ovarian yolk sac tumor (OYST) is a very rare malignancy arising in young women. Our objective was to determine whether an early decline in serum alpha-fetoprotein (AFP) during chemotherapy has a prognostic impact. METHODS This retrospective study is based on prospectively recorded OYST cases at Gustave Roussy (Cancer Treatment Center). Survival curves were estimated using the Kaplan-Meier method. The serum AFP decline was calculated with the formula previously developed and validated in male patients with poor prognosis non-seminomatous germ cell tumors. Univariate and multivariate analyses were performed using the log-rank test and logistic regression, respectively. RESULTS Data on AFP were available to calculate an early AFP decline in 57 patients. All patients had undergone surgery followed by chemotherapy. The 5-year overall survival (OS) and event-free survival (EFS) rates were 86% (95% CI: 74%-93%) and 84% (95% CI: 73%-91%), respectively. The disease stage, presence of ascites at presentation, use of the BEP regimen, serum AFP half-life and an early AFP decline were significantly predictive factors for OS and EFS in the univariate analysis. The OS rate was 100% and 49% (95% CI: 26%-72%) in patients with a favorable AFP decline and in those with an unfavorable decline, respectively (p<0.001). In the multivariate analysis, only the presence of ascites at diagnosis (RR=7.3, p=0.03) and an unfavorable early AFP decline (RR=16.9, p<0.01) were significant negative predictive factors for OS. CONCLUSIONS An early AFP decline during chemotherapy is an independent prognostic factor in patients with OYSTs. CONFLICT OF INTEREST STATEMENT No conflict of interest.
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Affiliation(s)
- Thibault de la Motte Rouge
- Department of Medical Oncology, Centre Eugène Marquis, Av de la bataille Flandres-Dunkerque, CS 44229, F-35042 Rennes, France
| | - Patricia Pautier
- Department of Cancer Medicine, Institut Gustave-Roussy, 114 rue Edouard Vaillant, F-94805 Villejuif, France
| | - Catherine Genestie
- Department of Biopathology, Institut Gustave-Roussy, 114 rue Edouard Vaillant, F-94805 Villejuif, France
| | - Annie Rey
- Department of Biostatistics, Institut Gustave-Roussy, 114 rue Edouard Vaillant, F-94805 Villejuif, France
| | - Sébastien Gouy
- Department of Surgery, Institut Gustave-Roussy, 114 rue Edouard Vaillant, F-94805 Villejuif, France
| | - Alexandra Leary
- Department of Cancer Medicine, Institut Gustave-Roussy, 114 rue Edouard Vaillant, F-94805 Villejuif, France
| | - Christine Haie-Meder
- Department of Radiotherapy, Institut Gustave-Roussy, 114 rue Edouard Vaillant, F-94805 Villejuif, France
| | - Pierre Kerbrat
- Department of Medical Oncology, Centre Eugène Marquis, Av de la bataille Flandres-Dunkerque, CS 44229, F-35042 Rennes, France
| | - Stéphane Culine
- Department of Medical Oncology, CHU Hôpital Saint Louis, 1 avenue Claude-Vellefaux, F-75010 Paris, France
| | - Karim Fizazi
- Department of Cancer Medicine, Institut Gustave-Roussy, 114 rue Edouard Vaillant, F-94805 Villejuif, France
| | - Catherine Lhommé
- Department of Cancer Medicine, Institut Gustave-Roussy, 114 rue Edouard Vaillant, F-94805 Villejuif, France.
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31
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Affiliation(s)
- George J Bosl
- Memorial Sloan Kettering Cancer Center, New York, NY
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