Clinical outcome following post-chemotherapy retroperitoneal lymph node dissection in men with intermediate- and poor-risk nonseminomatous germ cell tumour
Clinical outcome following post-chemotherapy retroperitoneal lymph node dissection in men with intermediate- and poor-risk nonseminomatous germ cell tumour
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DOI：
10.1111/j.1464-410x.2007.06740.x
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发表时间：
2007-05-01
影响因子：
4.5
通讯作者：
Sheinfeld, Joel
中科院分区：
文献类型：
--
作者：
Shayegan, Bobby;Carver, Brett S.;Sheinfeld, Joel
目的评价国际生殖细胞癌协作组(IGCCCG)初诊为中低危转移性非精原细胞睾丸生殖细胞肿瘤(NSGCT)后化疗加腹膜后淋巴清扫术(RPLND)的疗效。采用Kaplan-Meier方法估计无进展概率(PFP)和疾病特异性生存(DSS)。结果68例(43%)和89例(57%)患者被划分为中危和差危患者。在RPLND时，腹膜后残留肿块的中位数为3.0厘米，29名(19%)男性血清肿瘤标志物(甲胎蛋白、人绒毛膜促性腺激素或两者均有)升高。腹膜后残留肿块完全切除147例(94%)，腹膜后组织学显示纤维化73例(47%)，畸胎瘤63例(40%)，GCT存活21例(13%)。5年总体DSS和PFP分别为81%和70%。低风险NSGCT患者的疾病进展风险并不比那些中等风险NSGCT患者更大。在多因素分析中，残留肿块大小、不完全手术切除、畸胎瘤和存活生殖细胞癌的存在是RPLND后疾病进展的独立预测因素。结论晚期NSGCT患者在化疗和残留肿块切除的同时，可以长期免于疾病进展。我们的数据表明，肿瘤对化疗的反应，加上所有残留肿块的完全切除，预示着长期不会出现疾病进展。
OBJECTIVE To evaluate the outcome in patients treated with chemotherapy and retroperitoneal lymph node dissection (RPLND) after an initial diagnosis of International Germ Cell Cancer Collaborative Group (IGCCCG) intermediate- and poor-risk metastatic nonseminomatous testicular germ cell tumour (NSGCT), as the integration of chemotherapy and surgery in managing advanced NSGCT continues to develop.PATIENTS AND METHODS Between 1989 and 2003, 157 patients initially diagnosed with IGCCCG intermediate- and poor-risk NSGCT had RPLND after chemotherapy at the authors' institution, with a median follow-up of 36 months. Progression-free probability (PFP) and disease-specific survival (DSS) were estimated using the Kaplan-Meier method. Cox proportional hazards regression analysis was used to assess the prognostic significance of risk factors for disease progression after RPLND.RESULTS In all, 68 (43%) and 89 (57%) patients were assigned as intermediate- and poor-risk, respectively. At the time of RPLND the median residual retroperitoneal mass was 3.0 cm and 29 (19%) men had elevated serum tumour markers (alpha-fetoprotein, human chorionic gonadotrophin, or both). Retroperitoneal residual masses were completely resected in 147 (94%) patients; retroperitoneal histology revealed fibrosis in 73 (47%), teratoma in 63 (40%) and viable GCT in 21 (13%). The 5-year overall DSS and PFP were 81% and 70%, respectively. Patients with poor-risk NSGCT were at no greater risk of disease progression than those with intermediate-risk NSGCT. In a multivariate analysis, residual mass size, incomplete surgical resection and the presence of teratoma and viable germ cell cancer independently predicted disease progression after RPLND.CONCLUSIONS Patients with advanced NSGCT have long-term freedom from disease progression when chemotherapy is combined with resection of residual masses. Our data suggest that the tumour response to chemotherapy, coupled with complete resection of all residual masses, predicts long-term freedom from disease progression.