Application of the International Germ Cell Consensus Classification to the Nova Scotia population of patients with germ cell tumours
DOI:
https://doi.org/10.5489/cuaj.1043Abstract
Background: The International Germ Cell Consensus Classification
(IGCCC) is the internationally accepted, clinically based prognostic
classification used to assist in the management and research of
metastatic germ cell tumours (GCTs). The goal of this study was
to determine whether the IGCCC is applicable to a populationbased
cohort.
Methods: We completed a retrospective chart review of patients
who received diagnoses of GCT in Nova Scotia between 1984
and 2004 and who received treatment with platin-based chemotherapy
for metastatic disease. We assigned the IGCCC to each
patient based on the site of the primary lesion, the presence or
absence of nonpulmonary visceral metastases and prechemotherapy
tumour marker values. We calculated Kaplan–Meier estimates
of 5-year progression-free survival (PFS) and overall survival for
each IGCCC group.
Results: The study cohort comprised 129 patients. The distribution
and outcomes in each group of patients in Nova Scotia was similar
to that published in the IGCCC. Among patients with nonseminoma
GCTs (NSGCT) 61% had good, 22% had intermediate and
17% had poor prognoses. Among those with seminomas, 85% had
good and 15% had intermediate prognoses. Among patients
with NSGCTs, the 5-year PFS was 90%, 69% and 55%, and the
5-year overall survival was 94%, 84%, 61% in the good, intermediate,
and poor prognostic categories respectively. Among
patients with seminomas, the 5-year PFS was 95% and 50% and
the 5-year overall survival was 94% and 50% in the good and intermediate
prognostic categories, respectively.
Conclusion: The IGCCC seems applicable to a population-based
cohort, with similar distribution of categories and clear prognostic
ability.
Contexte : L’IGCCC (International Germ Cell Consensus Classification)
est un système de classification pronostique mondialement
reconnu, basé sur les données cliniques et utilisé pour faciliter
la prise en charge des tumeurs germinales métastatiques et la
recherche sur ces tumeurs. Le but de la présente étude était de déterminer
si cette classification s’applique à une cohorte de population.
Méthodologie : On a mené une étude rétrospective par examen de
dossiers de patients ayant reçu un diagnostic de tumeur germinale
en Nouvelle-Écosse entre 1984 et 2004 et traités par chimiothérapie
antimétastatique à base de platine. On a classé les patients selon
l’IGCCC en fonction du siège de la tumeur primitive, de la présence
ou de l’absence de métastases viscérales non pulmonaires et des
valeurs des marqueurs tumoraux avant la chimiothérapie. La survie
sans progression de la maladie (SSP) et la survie globale (SG)
sur 5 ans pour chaque groupe formé en fonction de l’IGCCC ont
été évaluées par la méthode de Kaplan-Meier.
Résultats : La cohorte étudiée comptait 129 patients. La distribution
et l’issue du traitement étaient similaires pour tous les
patients à celles publiées dans la classification IGCCC. Chez les
patients avec tumeurs germinales non séminomateuses, 61 %
avaient un pronostic favorable, 22 % un pronostic moyen et 17 %
un pronostic médiocre. Chez les patients avec tumeurs séminomateuses,
85 % avaient un pronostic favorable et 15 % un pronostic
moyen. Chez les patients avec tumeurs germinales non séminomateuses,
la SSP après 5 ans était de 90 %, 69 % et 55 % et
la survie globale après 5 ans était de 94 %, 84 % et 61 % en fonction
de pronostiques favorable, moyen et médiocre, respectivement.
Chez les patients avec tumeurs séminomateuses, la SSP après 5 ans
était de 95 % et 50% et la survie globale après 5 ans était de
94 % et 50 % en fonction de ces mêmes catégories pronostiques.
Conclusion : L’IGCCC semble bien s’appliquer à une cohorte de
population; la distribution entre les classes est similaire, et la capacité
pronostique est très bonne.
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