Annals of Oncology 8:531-538, 1997
© 1997 European Society for Medical Oncology
research-article |
Postchemotherapy resections of residual masses from metastatic non-seminomatous testicular germ cell tumors*
1Department of Hemalology/Oncology/Immunology. UKL – Medical Center II Eberhard-Karls-Universily, Tübingen, Germany
2Department of Hemalology/Oncology, Martin-Luther-Unirersity Halle/Wittenberg, Germany
3Department of Urology, University Medical School Hannover, Germany
Correspondence to: C. Bokemeyer, MD Dept. of Hematology, Oncology, Immunology UKL - Medical Center II Eberhard-Karls-University Tübingen Otfried-Müller-Str. 10 D-72076 Tubingen Germany
PURPOSE: To analyse the frequencies of histological findings, predictive factors for the presence of undifferentiated tumor and variables influencing the survival of patients with non-seminomatous germ cell tumors who underwent secondary resection of residual masses after cisplatin-based combination chemotherapy.
PATIENTS AND METHODS: 134 patients with a median age of 26 years (15–47) undergoing at least one surgical intervention at Hannover University Medical School were included. One hundred nine patients had received first-line chemotherapy and 25 underwent surgery after second-line chemotherapy.
RESULTS: After first-line chemotherapy the distribution of histological findings was 52% necrosis, 27% differentiated teratoma and 21% undifferentiated tumor for 82 patients with marker negative PR (PRm–). Incompletely resected mass and failure to achieved complete tumor marker normalisation were significantly associated with the finding of undifferentiated tumor. Five-year progression-free survival rates according to histological findings were 78%, 67% and 66% for necrosis, differentiated teratoma and undifferentiated tumor. Patients with undifferentiated tumor in the resected specimen routinely received postoperative additional chemotherapy. Factors associated with a worse overall survival were progressive disease within three months, persistent AFP elevation prior to surgery, prechemotherapy elevated LDH levels or mediastinal lymph node involvement at primary diagnosis. In 8 of 27 patients (30%) undergoing multiple resections at different sites a dissimilar histology was found. In the 25 patients operated after salvage chemotherapy undifferentiated tumor was found in 80%. A five-year survival of 44% compared to 80% after first-line chemotherapy was achieved.
CONCLUSIONS: Resection of residual tumors after first-line chemotherapy remains essential in the treatment of metastatic testicular cancer. Undifferentiated tumor may still be found in 20% of patients despite achieving PRm- after first-line chemotherapy. Necrosis is found in only 50% of marker normalized patients after first-line and approximately 30% after second-line chemotherapy. Future studies have to prove whether the combination of clinical prognostic factors and the use of PET-scanning will allow to spare subsets of patients from secondary resection.
metastastic non-seminomatous testicular cancer, postchemotherapy residual mass, secondary surgical intervention, outcome analysis, predictive factors for histological findings
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