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Purpose <p>Non-seminomatous germ cell tumors (NSGCT) are considered highly curable malignancies in developed nations. However, outcomes in low- and middle-income countries remain suboptimal, and literature describing outcomes and barriers to cure in advanced NSGCT from resource-limited settings is scarce.</p> Methods <p>A retrospective analysis was conducted among patients with advanced NSGCT treated at a tertiary cancer center in central India. Primary endpoint was overall survival (OS), while secondary endpoints included progression-free survival (PFS), and treatment-related toxicity.</p> Results <p>Among 108 evaluated patients with testicular cancer, 60% had NSGCT and 51% had advanced disease. The median age was 28 years, and the median time from symptom onset to presentation was 5.5 weeks. Disease staging revealed 9% stage IIC, 6% stage IIIA, 24% stage IIIB, and 61% stage IIIC disease. Nearly half of the patients (49%) were underweight, and 45% had hypoalbuminemia. Treatment delays and/or dose modifications occurred in 81% of patients, primarily due to treatment-related toxicities. Hematologic toxicities were frequent, including grade 3–4 anemia (23%), neutropenia (19%), and febrile neutropenia (29%). There were two treatment-related deaths. At a median follow-up of 21 months, the median PFS and OS were 8.6 months and 11.9 months, respectively. Normal body mass index (BMI) was significantly associated with improved PFS (<i>p</i> = 0.03) and OS (<i>p</i> = 0.015).</p> Conclusion <p>Outcomes for advanced NSGCT in this resource-limited setting were significantly inferior to those reported from high-income countries. Key contributing factors included delayed presentation, advanced disease at diagnosis, poor chemotherapy tolerance, and frequent treatment delays and dose modifications.</p>

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Barriers to cure in advanced non-seminomatous germ cell tumors: a clinical audit from a resource-limited region in India

  • 期刊论文

  • 出版模式：

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  • 发表日期：

    2026年2月18日

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  • Fen Saj,
  • Rachna Sahu,
  • Deepak Dabkara,
  • Senthilkumar Ramasamy,
  • Ajit Agarwal,
  • Shravan Nadkarni,
  • Gourav Gupta,
  • Jay Kumar Rai,
  • Lade Gaurav,
  • Sandeep Ojha,
  • Bhawna Sirohi

摘要

Purpose

Non-seminomatous germ cell tumors (NSGCT) are considered highly curable malignancies in developed nations. However, outcomes in low- and middle-income countries remain suboptimal, and literature describing outcomes and barriers to cure in advanced NSGCT from resource-limited settings is scarce.

Methods

A retrospective analysis was conducted among patients with advanced NSGCT treated at a tertiary cancer center in central India. Primary endpoint was overall survival (OS), while secondary endpoints included progression-free survival (PFS), and treatment-related toxicity.

Results

Among 108 evaluated patients with testicular cancer, 60% had NSGCT and 51% had advanced disease. The median age was 28 years, and the median time from symptom onset to presentation was 5.5 weeks. Disease staging revealed 9% stage IIC, 6% stage IIIA, 24% stage IIIB, and 61% stage IIIC disease. Nearly half of the patients (49%) were underweight, and 45% had hypoalbuminemia. Treatment delays and/or dose modifications occurred in 81% of patients, primarily due to treatment-related toxicities. Hematologic toxicities were frequent, including grade 3–4 anemia (23%), neutropenia (19%), and febrile neutropenia (29%). There were two treatment-related deaths. At a median follow-up of 21 months, the median PFS and OS were 8.6 months and 11.9 months, respectively. Normal body mass index (BMI) was significantly associated with improved PFS (p = 0.03) and OS (p = 0.015).

Conclusion

Outcomes for advanced NSGCT in this resource-limited setting were significantly inferior to those reported from high-income countries. Key contributing factors included delayed presentation, advanced disease at diagnosis, poor chemotherapy tolerance, and frequent treatment delays and dose modifications.