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Background <p>Germ cell tumors (GCTs) are highly curable, yet a subset of patients with metastatic disease experience early death (ED) soon after starting first-line chemotherapy. These patients are underrepresented in trials, and risk factors remain unclear.</p> Methods <p>We performed a retrospective multicenter cohort study including adults ( ≥ 18 years) with metastatic GCT who died within 3 months of completing their last cycle of first-line chemotherapy. Primary outcomes were cause and timing of death; secondary endpoints included clinical predictors of acute respiratory failure (ARF) and very early death ( ≤ 30 days).</p> Results <p>Among 102 patients (1.7% of treated cases), 69.6% had non-seminoma, 83.3% testicular primaries, and 67.6% poor-risk disease. Median time to death was 28 days (range, 2–179). Leading causes were ARF (34.1%), disease progression (16.7%), septic shock (15.7%), hemorrhage (12.7%), and cardiovascular events (4.0%). ARF correlated with &gt; 50% lung involvement, dyspnoea, and haemoptysis, but not choriocarcinoma histology or bleomycin use. Mostly, ED (51%) was associated with liver metastases, massive lung involvement, β-hCG &gt; 50,000 mIU/mL, ECOG 2–3, elevated neutrophil/lymphocyte ratio, and need for intensive care (all <i>P</i> &lt; 0.05).</p> Conclusions <p>Early death in metastatic GCT, though rare, remains a critical clinical issue. Early identification, adapted induction regimens, and optimized supportive care may help prevent avoidable mortality.</p>

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Risk factors and causes of early death in germ cell tumors: a Global Society for Rare GU tumors study

  • 期刊论文

  • 出版模式：

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  • 发表日期：

    2026年6月2日

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  • Michal Mego,
  • Edgar Israelyan,
  • Robert J. Hamilton,
  • Axel Heidenreich,
  • Umberto Basso,
  • Patrizia Giannatempo,
  • Tomas Buchler,
  • Klaus-Peter Dieckmann,
  • Robert Huddart,
  • Bruno Vincenzi,
  • Kwonoh Park,
  • Jorge Aparicio,
  • Alexei Tryakin,
  • Ali Amiri,
  • Pavlina Malcharkova,
  • Melanie Claps,
  • Marija Miletic,
  • Lucia Chaloupkova,
  • Markus Angerer,
  • Philippe E. Spiess,
  • Ugo De Giorgi,
  • Ugo De Giorgi

摘要

Background

Germ cell tumors (GCTs) are highly curable, yet a subset of patients with metastatic disease experience early death (ED) soon after starting first-line chemotherapy. These patients are underrepresented in trials, and risk factors remain unclear.

Methods

We performed a retrospective multicenter cohort study including adults ( ≥ 18 years) with metastatic GCT who died within 3 months of completing their last cycle of first-line chemotherapy. Primary outcomes were cause and timing of death; secondary endpoints included clinical predictors of acute respiratory failure (ARF) and very early death ( ≤ 30 days).

Results

Among 102 patients (1.7% of treated cases), 69.6% had non-seminoma, 83.3% testicular primaries, and 67.6% poor-risk disease. Median time to death was 28 days (range, 2–179). Leading causes were ARF (34.1%), disease progression (16.7%), septic shock (15.7%), hemorrhage (12.7%), and cardiovascular events (4.0%). ARF correlated with > 50% lung involvement, dyspnoea, and haemoptysis, but not choriocarcinoma histology or bleomycin use. Mostly, ED (51%) was associated with liver metastases, massive lung involvement, β-hCG > 50,000 mIU/mL, ECOG 2–3, elevated neutrophil/lymphocyte ratio, and need for intensive care (all P < 0.05).

Conclusions

Early death in metastatic GCT, though rare, remains a critical clinical issue. Early identification, adapted induction regimens, and optimized supportive care may help prevent avoidable mortality.