Factors Associated With Choriocarcinoma Syndrome Development in Poor-Risk Patients With Germ Cell Tumors

Katarina Rejlekova; Katarina Kalavska; Marek Makovnik; Nikola Hapakova; Michal Chovanec; Valentina De Angelis; Jana Obertova; Patrik Palacka; Zuzana Sycova-Mila; Jozef Mardiak; Michal Mego

doi:10.3389/fonc.2022.911879

Factors Associated With Choriocarcinoma Syndrome Development in Poor-Risk Patients With Germ Cell Tumors

Front Oncol. 2022 Jun 17:12:911879. doi: 10.3389/fonc.2022.911879. eCollection 2022.

Authors

Katarina Rejlekova^{1

2}, Katarina Kalavska^{1

2

3}, Marek Makovnik^{1

4}, Nikola Hapakova^{1

2}, Michal Chovanec^{1

2}, Valentina De Angelis², Jana Obertova^{1

2}, Patrik Palacka^{1

2}, Zuzana Sycova-Mila², Jozef Mardiak^{1

2}, Michal Mego^{1

2

3}

Affiliations

¹ 2nd Department of Oncology, Faculty of Medicine, Comenius University and National Cancer Institute, Bratislava, Slovakia.
² Oncology Department, National Cancer Institute, Bratislava, Slovakia.
³ Translational Research Unit, Faculty of Medicine, Comenius University, National Cancer Institute, Bratislava, Slovakia.
⁴ Radiology Department, National Cancer Institute, Bratislava, Slovakia.

Abstract

Background: Germ cell tumors (GCTs) represent a highly curable cancer. However, a small proportion of poor-risk patients can develop choriocarcinoma syndrome (CS) connected with acute respiratory distress syndrome (ARDS) with a high mortality rate. Our retrospective study aimed to determine the risk factors of poor-risk GCTs susceptible to CS development.

Patients and methods: Using a computerized database and a systematic chart review, we identified the records of 532 patients with GCTs treated at the National Cancer Institute from 2000 to 2018. Ninety eligible patients with poor-risk GCTs based on IGCCCG classification were identified. All patients were treated with platinum-based induction chemotherapy. Clinicopathological variables were collected and analyzed in correlation with CS development.

Results: Nine (10%) of 90 patients developed CS in a median of 1 day (1-9 days) after chemotherapy administration. All patients died shortly after the chemotherapy start with a median of 4 days (3-35 days) due to ARDS development. In univariate analysis, metastatic lung involvement ≥50% of lung parenchyma, choriocarcinoma elements in histology specimen, dyspnea, cough, hemoptysis, ECOG PS ≥2, weight loss, hemoglobin ≤100 g/l, and NLR ≥3.3 at the time of presentation were associated with CS development. In multivariate analysis, ECOG PS ≥2 and metastatic lung involvement ≥50% were independently associated with CS. All patients with these two characteristics developed CS, compared to 0% with zero or one of these factors (p < 0.000001).

Conclusions: In our study, we identified factors associated with CS development. These factors might improve the risk stratification of the patients susceptible to CS and improve their outcome.

Keywords: acute respiratory distress syndrome; choriocarcinoma syndrome; germ cell tumors; human choriogonadotropin; induction chemotherapy; poor-risk.