Patterns of care and outcomes of men with germ cell tumors in a high‐volume Australian center

• Published in: Asia-Pacific journal of clinical oncology 2022-04, Vol.18 (2), p.e23-e31
• Main Authors: Arasaratnam, Malmaruha, Balakrishnar, Bavanthi, Crumbaker, Megan, Turner, Sandra, Hayden, Amy J, Brooks, Andrew, Patel, Manish I, Lau, Howard, Woo, Henry, Bariol, Simon, Gurney, Howard
• Format: Article
• Language: English
• Subjects: Adult; Australia - epidemiology; Chemotherapy; germ cell tumor; Humans; Male; Malignancy; Mediastinum; Metastases; Neoplasms, Germ Cell and Embryonal - epidemiology; Neoplasms, Germ Cell and Embryonal - therapy; Patients; Radiation therapy; Retroperitoneum; Retrospective Studies; Seminoma; Seminoma - diagnosis; Seminoma - epidemiology; Seminoma - therapy; survival outcomes; Testicular Neoplasms - diagnosis; Testicular Neoplasms - epidemiology; Testicular Neoplasms - therapy; treatment trends; Tumors
• ISSN: 1743-7555; 1743-7563
• DOI: 10.1111/ajco.13548

Aim To evaluate disease presentation, treatment practices, and outcomes of patients with germ cell tumor (GCT) treated in a high‐volume cancer center in Australia. Methods This is a retrospective analysis of 609 patients diagnosed with GCT in the Sydney West Cancer Network between 1990 and 2013. Cause and date of death, and second malignancy information was sourced from The Centre for Health Record Linkage. Results The median age was 33 years (range, 14‐85). Primary site was testis in 590 (96.9%), mediastinum in nine (1.5%), and retroperitoneum in nine (1.5%). History of undescended testis was present in 48 (7.9%). Pure seminoma was seen in 334 (54.8%), with 274 (82.0%) being stage I. There was a decline in use of adjuvant radiotherapy from 83% in 1990‐1997 to 29% in 2006‐2013. Nonseminoma GCT (NSGCT) was diagnosed in 275 (45.2%), with 162 (58.9%) being stage 1. Active surveillance has increased as the initial treatment, from 58% between 1990 and 1997 to 89% between 2006 and 2013. Metastatic disease at presentation was seen in 162 (26.6%): 55 (34.0%) seminoma and 107 (66.0%) NSGCT. With median of 15‐year follow‐up, 18 (3.0%) have died from GCT and 70 (11.5%) from all causes. Ten‐year overall survival was 93% and GCT‐specific survival was 97%. Forty patients developed a secondary malignancy, with 38 receiving chemotherapy, radiotherapy, or both. Conclusions This large Australian series illustrates a changing pattern of care and outcomes and compares them favorably with other series. This serves as a basis for future comparison of outcomes for this malignancy. Excellent long‐term survival outcomes have been demonstrated in men diagnosed with germ cell tumor managed in a high‐volume Australian institute where there has been an increasing adoption of active surveillance in early stage disease minimizing morbidity associated with cancer treatment.