Predictors of First-Line Progression-Free Survival in Testicular Germ Cell Tumors: A Retrospective Cohort Study

Background: Testicular germ cell tumors are usually highly responsive to platinum-based treatment. However, outcomes remain heterogeneous. This exploratory retrospective study assessed factors associated with first-line progression-free survival and with the need for second-line systemic therapy. Methods: We reviewed 41 patients treated for testicular germ cell tumors at a single oncology center. Clinical, pathological, metastatic, treatment-related, and biochemical variables were extracted from medical records. First-line progression-free survival was evaluated using exploratory univariable Cox regression. Variables associated with second-line treatment were assessed using exploratory univariable analyses. Results: The median age was 37 years and most of the patients had non-seminomatous histology. A greater mean decline of initially elevated serum markers after the first chemotherapy cycle was associated with longer first-line progression-free survival in both the overall cohort and the non-seminomatous subgroup. The need for second-line systemic treatment was associated with stage III disease, metastasis at diagnosis, and elevated baseline serum tumor markers. Conclusions: In this cohort, baseline disease burden and marker elevation were the clearest adverse clinical signals. Moreover, early marker decline may add information about treatment sensitivity and tailor follow-up.