Survival

Published studies evaluating the therapeutic benefit of post-chemotherapy surgery in patients with elevated serum tumor markers have reported survival rates ranging from 33% to 75% [4,5,8-11]. Ravi and colleagues [11] reported a disease-free survival in 17 (57%) of 30 marker-positive patients at a median follow-up of 57 months (range: 2 to 150). Most of these studies have reported more favorable outcomes in patients with an elevated serum AFP (as opposed to bHCG), and stable serum tumor markers at time of surgery [5,9,10].

In the Indiana experience, the 5-year overall survival for the 114 patients (50 patients receiving first-line, and 64 receiving second-line chemotherapy, respectively, before surgery) was 53.9% (Fig. 1A). Sixty-one patients (53.5%) are alive and the median follow-up time for survivors was 72 months (range: 24 to 168). All patients alive had a minimum follow-up of 2 years. Fifty-three patients died of disease with a median time to death of 8.0 months (range: 1 to 84). Survival distribution based on serum marker elevation and retroperitoneal pathology is seen in Fig. 1B, C, respectively. The 5-year overall survival based on pathology was 31.4%, 77.5%, and 85.7% for germ-cell cancer, teratoma, and fibrosis, respectively (P — .0001). The 5-year overall survival for the primary chemotherapy group was 81.1%.

Overall survival for 114 patients

0 12 24 36 48 60 72 84 96 108 120 Time in months

B Survival based on elevated serum tumor markers

B Survival based on elevated serum tumor markers

AFP/HCG

n=51

n=30

n=22 n=18

n=58

n=35

n=26 n=15

n=4

n=1

n=1 n=1

0 12

24 36

48 60 72

Time in months

84 96 108 120

84 96 108 120

Survival based on pathology

Survival based on pathology

p Value = 0.00001

0 12 24 36 48 60 72 84 96 108 120 Time in months

Fig. 1. (A) Overall survival for the 114 patients in the study cohort. The majority of patients who relapsed and died did so by 24 months. (B) Overall survival for the 114 patients based on serum tumor marker elevation. There was no difference in survival for the 51 patients with an elevated HCG and the 58 patients with an elevated AFP. Only four patients had elevation of both serum tumor markers. (C) Overall survival categorized by retroperitoneal pathology. The 5-year overall survival was 31.4%, 77.5%, and 85.7% for germ-cell cancer, teratoma, and fibrosis, respectively (P = .0001).

p Value = 0.00001

0 12 24 36 48 60 72 84 96 108 120 Time in months

Fig. 1. (A) Overall survival for the 114 patients in the study cohort. The majority of patients who relapsed and died did so by 24 months. (B) Overall survival for the 114 patients based on serum tumor marker elevation. There was no difference in survival for the 51 patients with an elevated HCG and the 58 patients with an elevated AFP. Only four patients had elevation of both serum tumor markers. (C) Overall survival categorized by retroperitoneal pathology. The 5-year overall survival was 31.4%, 77.5%, and 85.7% for germ-cell cancer, teratoma, and fibrosis, respectively (P = .0001).

The median survival time for the 64 patients in the salvage group was 15 months (95% confidence interval, 9.0 to 21 months) with a 5-year overall survival of 33.3% (P = .0001).

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