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Teratoma linked to higher cumulative incidence of germ cell tumor-related death
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Teratoma appeared associated with a higher cumulative incidence of disease-related death among men with nonseminomatous germ cell primary tumors, according to results of a retrospective study published in Journal of Clinical Oncology.
“Teratoma is resistant to chemotherapy, a consequence of terminal differentiation,” Samuel A. Funt, MD, medical oncologist specializing in germ cell tumors at Memorial Sloan Kettering Cancer Center, and colleagues wrote. “Because teratoma does not secrete a serum marker, the impact of somatic differentiation on outcome is uncertain.”
Funt and colleagues analyzed primary tumor specimens collected between 1975 and 1996 from 232 patients with metastatic germ cell tumors treated with first-line platinum-based chemotherapy. Most of the patients (n = 193; median age, 27 years; range, 16-63) had nonseminomatous germ cell tumors (NSGCT). Researchers noted an element of teratoma in 82 NSGCT primary tumors.
Researchers examined whether teratoma in the pretreatment primary tumor was associated with treatment resistance and/or survival among these patients.
Cumulative incidence of disease-related death served as the study’s primary endpoint.
After a median follow-up of 17 years (range, 0.3-35), 58 patients with NSGCT had died, including 47 as a result of their germ cell tumors.
Most germ cell tumor-related deaths occurred in the first 5 years and were associated with pretreatment risk status (P < .001). Deaths of other causes rose slowly over 15 years but were not associated with risk status.
Researchers observed a higher 5-year cumulative incidence of disease-related death among patients who had NSGCT with teratoma (27.4%) than among patients without teratoma (17.4%) or seminoma (10.3%; P = .03).
Mature teratoma was associated with a higher 5-year cumulative incidence of disease-related death (38.1%) than immature teratoma (19.9%) or NSGCT without teratoma (17.4%; P = .01).
The study’s retrospective nature served as its primary limitation.
“Teratoma is not inert; its genomic instability is at least as great as embryonal carcinoma,” Funt and colleagues wrote. “Modern molecular or genetic analysis may be useful if it can be applied rapidly at diagnosis. To untangle the relationship between teratoma and long-term outcome and to clarify the role of teratoma in treatment planning, additional long-term follow-up studies are needed.”
The results of this study could help pave the way for updates to the International Germ Cell Cancer Collaborative Group classification system and are a step forward in the effort to personalize treatment for metastatic germ cell tumors, Andrea Necchi, MD, oncologist in the department of medical oncology at National Institute of Hospitalization and Scientific Care in Italy, and colleagues wrote in an accompanying editorial.
“Pending validation in external and larger data sets, the authors’ findings could be important to optimize treatment and follow-up indications within the potentially reclassified prognostic categories of metastatic germ cell tumors or suggest a possible direction for the new classification system,” Necchi and colleagues wrote. – by John DeRosier
Disclosures: Funt reports stock and other ownership in Allogene Therapeutics, Hubble, Kite Pharma, Kronos Bio, Neogene Therapeutics, UroGen Pharma and Vida Ventures. Please see the study for all other authors’ relevant financial disclosures. Necchi reports stock ownership in, advisory roles with, honoraria from and/or research funding from Astellas Pharma, AstraZeneca, Bayer, Bristol-Myers Squibb, Foundation Medicine, Incyte, Janssen Pharmaceuticals, Merck and Rainier Therapeutics, as well as travel expenses from Merck, Roche and Rainier Therapeutics. Please see the editorial for all other authors’ relevant financial disclosures.
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