Muhammad Shahzad Rauf, Hazza A Alzahrani, Ali Alhanash, Fahad Almugbel, Ali Alqahtani, Ahmed Alzahrani, Tusneem Ahmed M Elhassan, Huda Syed, Mohammed Saad Alharbi, Ali Aljubran, Shouki Bazarbashi
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引用次数: 0
Abstract
Purpose: Optimal salvage treatment for relapsed/refractory germ cell tumors in men remains controversial. The options include conventional-dose chemotherapy (CDCT) and high-dose chemotherapy with autologous stem cell transplantation (HDCT-ASCT). There is currently a lack of data from the Middle East on this topic. This study presents the largest single-institution experience in the region.
Methods: We retrospectively examined patients aged 14 years or older, treated at King Faisal Hospital and Research Center, Riyadh, between 2010 and 2022. Patients previously received first-line, cisplatin-based chemotherapy. The treatment consisted of either CDCT or HDCT-ASCT. The primary endpoints were event-free survival (EFS) and overall survival (OS).
Results: Study included 46 patients, of whom 24 and 22 received CDCT and HDCT-ASCT, respectively. Using the IPFSG prognostic model as per local institutional practice, patients in the very low, low, and intermediate risk groups received CDCT. In the 24-patient CDCT group, 16 (66%) were high/very high risk, and only 2 (8%) demonstrated primary refractoriness. Contrarily, of the 22 patients who received HDCT-ASCT, 20 (91%) were classified as high/very high risk, and 17 (77%) were primary refractory to first-line treatment. The HDCT-ASCT cohort was heavily weighted toward high/very high risk. HDCT-ASCT group (59%) had a higher complete remission rate than the CDCT group (59% vs 41%). With a median follow-up of 35 months, the 3-year OS was 60% in the CDCT group and 53% in the HDCT-ASCT group, whereas the 3-year EFS rates were 54% and 43%, respectively.
Discussion: Results indicated that HDCT-ASCT achieved a superior response rate compared with CDCT, despite an adverse prognostic profile and numerically comparable survival outcomes with the lower-risk cohort treated with CDCT. These findings suggest that the selection of higher-risk patients for a more intensive therapy is an effective strategy. However, direct comparison is limited by the retrospective nature.
目的：男性复发/难治性生殖细胞肿瘤的最佳抢救治疗仍有争议。选择包括常规剂量化疗（CDCT）和自体干细胞移植大剂量化疗（HDCT-ASCT）。目前缺乏来自中东的关于这一主题的数据。这项研究展示了该地区最大的单一机构经验。方法：我们回顾性调查了2010年至2022年间在利雅得费萨尔国王医院和研究中心接受治疗的14岁及以上患者。患者先前接受一线顺铂化疗。治疗包括CDCT或HDCT-ASCT。主要终点为无事件生存期（EFS）和总生存期（OS）。结果：共纳入46例患者，其中CDCT 24例，HDCT-ASCT 22例。根据当地机构的实践，使用IPFSG预后模型，极低、低和中危组的患者接受了CDCT。在24例CDCT患者中，16例（66%）为高/极高风险，只有2例（8%）表现为原发性难治性。相反，在接受HDCT-ASCT的22例患者中，20例（91%）被分类为高风险/极高风险，17例（77%）对一线治疗原发性难治性。在HDCT-ASCT队列中，高风险/非常高风险的权重很大。HDCT-ASCT组（59%）的完全缓解率高于CDCT组（59% vs 41%）。中位随访时间为35个月，CDCT组3年OS为60%，HDCT-ASCT组为53%，而3年EFS率分别为54%和43%。讨论：结果表明，尽管HDCT-ASCT与低风险的CDCT治疗组相比存在不良的预后和可比较的生存结果，但与CDCT相比，HDCT-ASCT获得了更高的缓解率。这些发现表明，选择高风险患者进行更强化的治疗是一种有效的策略。然而，直接比较受到追溯性的限制。
期刊介绍：
Research and Reports in Urology is an international, peer-reviewed, open access, online journal. Publishing original research, reports, editorials, reviews and commentaries on all aspects of adult and pediatric urology in the clinic and laboratory including the following topics: Pathology, pathophysiology of urological disease Investigation and treatment of urological disease Pharmacology of drugs used for the treatment of urological disease Although the main focus of the journal is to publish research and clinical results in humans; preclinical, animal and in vitro studies will be published where they will shed light on disease processes and potential new therapies. Issues of patient safety and quality of care will also be considered.
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