Late relapse of testicular germ cell tumor: An individual patient data meta-analysis of disease characteristics, treatments, and oncological outcomes.

Abstract

Introduction: Late relapse (LR) of testicular germ cell tumor (TGCT) is a relatively rare event with limited data to help refine evidence-based decision-making. This individual patient data meta-analysis aims to analyze disease characteristics, treatment modalities, and factors affecting oncological outcomes of TGCT patients suffering from LR.

Material and methods: A systematic search and individual patient data gathering was performed. The primary end points were disease-free survival (DFS) and cancer-specific survival (CSS).

Results: A total of 12 studies, comprising 240 patients, were selected for review. In multivariable analysis, surveillance as primary management of TGCT was associated with a higher risk of retroperitoneal LR (OR = 10.08, 95% CI: 2.34-43.31). On univariable analyses, longer time to LR, LR multiplicity, and chemotherapy (as the sole treatment of LR) were significantly associated with worse DFS and CSS, while pure teratoma at LR, teratoma element at LR, surgery (as the sole treatment of LR), and surgery-based combination treatment of LR were significantly associated with better DFS and CSS. Salvage chemotherapy for LR was associated with worse DFS and CSS compared to first-line chemotherapy in multivariable cox regression analysis (HR = 13.03, 95% CI: 1.13-150.25). Two decision-tree models are proposed to help shared decision making regarding chemotherapy-based vs surgery-only and surgery-based versus combination treatments; the accuracies of these models were 0.94 and 0.88.

Conclusions: Available data suggest a benefits to surgery alone or surgery-based combination therapy compared to chemotherapy alone for LR of TGCT. We propose decision-tree models to help clinical decision-making in TGCT patients with LR.