| Abstract
| - BACKGROUND: Because metastatic nonseminomatous germ cell cancer is a rare but treatablecancer, we have explored whether there is an association between the experience of the treatinginstitution with this disease and the long-term clinical outcome of the patients, particularlypatients with a poor prognosis. METHODS: We analyzed data on 380 patients treated in one of49 institutions participating in the European Organization for Research and Treatment ofCancer/Medical Research Council randomized trial of four cycles ofbleomycin-etoposide-cisplatin followed by two cycles of etoposide-cisplatin versus three cyclesof bleomycin-vincristine-cisplatin followed by three cycles ofetoposide-ifosfamide-cisplatin-bleomycin, both treatment regimens given with or withoutfilgrastim (granulocyte colony-stimulating factor). Institutions were divided into four groupsbased on the total number of patients entered in the trial. The groups were compared by use oftheCox proportional hazards model stratified for treatment with filgrastim and for patient prognosisas defined by the International Germ Cell Consensus Classification Group. With the use of thisclassification, only 65% of the patients had a poor prognosis. RESULTS: Patients treatedin the 26 institutions that entered fewer than five patients into the trial had an overall survivalthatwas statistically significantly worse (two-sided P = .010; hazard ratio =1.85; 95% confidence interval = 1.16-3.03) than that of patients treated in the 23institutions that entered five patients or more. Overall survival and failure-free survival weresimilar among institutions that entered at least five patients. The observed effect may be relatedto differences in adherence to the chemotherapy protocol and in the frequency and extent ofsurgery for residual masses, although only the differences in dose intensity achieved statisticalsignificance. CONCLUSIONS: Patients treated in institutions that entered fewer than fivepatients into the trial appeared to have poorer survival than those treated in institutions thatentered a larger number of patients with “poor-prognosis” nonseminoma.
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