Impact of the treating institution on survival of patients with "poor-prognosis" metastatic nonseminoma
Impact of the treating institution on survival of patients with "poor-prognosis" metastatic nonseminoma
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DOI：
10.1093/jnci/91.10.839
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发表时间：
1999-05-19
影响因子：
10.3
通讯作者：
Kaye, SB
中科院分区：
文献类型：
--
作者：
Collette, L;Sylvester, RJ;Kaye, SB
背景：由于转移性非半细胞瘤性生殖细胞癌是一种罕见但可治疗的癌症，我们探讨了治疗机构治疗这种疾病的经验与患者的长期临床结果之间是否存在关联，特别是预后较差的患者。方法:我们分析了在49家机构之一接受治疗的380名患者的数据，这些机构参加了欧洲癌症研究和治疗组织/医学研究委员会的随机试验，4个周期的博莱霉素-依托泊苷-顺铂，随后2个周期的依托泊苷-顺铂，3个周期的博莱泊苷-长春新碱-顺铂，随后3个周期的依托泊苷-异环磷酰胺-顺铂-博莱霉素。两种治疗方案均给予或不给予非格司提姆（粒细胞集落刺激因子）。根据进入试验的患者总数，将各机构分为四组，使用Cox比例风险模型对各组进行非格昔汀治疗分层和根据国际生殖细胞共识分类小组定义的患者预后进行比较。使用这种分类，只有65%的患者预后不良。结果：入组患者少于5人的26家机构患者的总生存率显著高于入组5人及以上的23家机构患者（双侧P = 0.010，风险比= 1.85,95%可信区间1.16-3.03）。在接受至少5名患者的机构中，总生存率和无失败生存率相似。观察到的效果可能与坚持化疗方案的差异以及残余肿块手术的频率和程度有关，尽管只有剂量强度的差异具有统计学意义。结论：在接受少于5例患者的机构接受治疗的患者，其生存率似乎低于接受大量“预后不良”非精原细胞瘤患者的机构接受治疗的患者。
Background: Because metastatic nonseminomatous germ cell cancer is a rare but treatable cancer, we have explored whether there is an association between the experience of the treating institution with this disease and the long-term clinical outcome of the patients, particularly patients with a poor prognosis. Methods: We analyzed data on 380 patients treated in one of 49 institutions participating in the European Organization for Research and Treatment of Cancer/ Medical Research Council randomized trial of four cycles of bleomycin-etoposide-cisplatin followed by two cycles of etoposide-cisplatin versus three cycles of bleomyein-vincristine-cisplatin followed by three cycles of etoposide-ifosfamide-cisplatin-bleomycin, both treatment regimens given with or without filgrastim (granulocyte colony-stimulating factor). Institutions were divided into four groups based on the total number of patients entered in the trial, The groups were compared by use of the Cox proportional hazards model stratified for treatment with filgrastim and for patient prognosis as defined by the International Germ Cell Consensus Classification Group. With the use of this classification, only 65% of the patients had a poor prognosis. Results: Patients treated in the 26 institutions that entered fewer than five patients into the trial had an overall survival that was statistically significantly morse (two-sided P = .010; hazard ratio = 1.85; 95% confidence interval 1.16-3.03) than that of patients treated in the 23 institutions that entered five patients or more. Overall survival and failure-free survival were similar among institutions that entered at least five patients. The observed effect may be related to differences in adherence to the chemotherapy protocol and in the frequency and extent of surgery for residual masses, although only the differences in dose intensity achieved statistical significance. Conclusions: Patients treated in institutions that entered fewer than five patients into the trial appeared to have poorer survival than those treated in institutions that entered a larger number of patients with "poor-prognosis" nonseminoma.