Outcomes After Multidisciplinary Management of Primary Mediastinal Germ Cell Tumors
Outcomes After Multidisciplinary Management of Primary Mediastinal Germ Cell Tumors
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DOI：
10.1097/sla.0000000000003754
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发表时间：
2021-12-01
影响因子：
9
通讯作者：
Jones, David R.
中科院分区：
文献类型：
--
作者：
Caso, Raul;Jones, Gregory D.;Jones, David R.
目的：我们研究了在一家高容量研究机构接受切除术和多学科治疗的PMNSGCT患者的治疗策略、总生存期（OS）和无进展生存期（PFS）。背景资料概要：PMNSGCT切除术后的结局特征不明确，与生存相关因素的数据有限。方法：我们回顾了1980年至2019年期间接受切除术的PMNSGCT患者。中位随访时间为3.4年。术前治疗（包括使用博莱霉素），手术治疗，复发和生存进行了检查。结果：共纳入113例患者[中位年龄：20岁]。28岁（范围：16-65岁）]。74%的患者术前血清肿瘤标志物（STM）正常化/降低。病理学包括仅坏死（25%）、畸胎瘤+/-坏死（20%）、活的非畸胎瘤生殖细胞肿瘤+/-畸胎瘤（41%）和继发性体细胞型恶性肿瘤+/-畸胎瘤（20%）。博莱霉素化疗与肺部并发症或90天死亡率无关。接受二线化疗后切除的患者的OS和PFS显著低于接受一线化疗后切除的患者。在多变量分析中，R1/R2切除（HR，3.92; P < 0.001）和术后STM增加（HR，4.98; P < 0.001）与较短的PFS相关;病理学上的坏死（HR，0.42，P = 0.043）与较长的PFS相关。在接受切除术的PMNSGCT患者中，切除完整性、术后病理学和术后STM与PFS相关。在接受切除术的患者中，诱导博莱霉素与肺部并发症或死亡率无关。接受二线化疗后切除的患者预后较差，长期生存率为22%。
Objective: We examined management strategies, overall survival (OS), and progression-free survival (PFS) among patients with PMNSGCTs undergoing resection and multidisciplinary management at a high-volume institution.Summary of Background Data: Outcomes after resection of PMNSGCTs are not well-characterized, with limited data on factors associated with survival.Methods: We reviewed patients with PMNSGCT who underwent resection between 1980 and 2019. Median follow-up was 3.4 years. Preoperative therapy (including use of bleomycin), surgical management, recurrence, and survival were examined. Factors associated with survival were analyzed using Cox regression.Results: In total, 113 patients were included [median age. 28 years (range, 16-65)]. Preoperative serum tumor markers (STMs) normalized/decreased in 74% of patients. Pathology included necrosis only (25%), teratoma +/- necrosis (20%), viable nonteratomatous germ cell tumor +/- teratoma (41%), and secondary somatic-type malignancy +/- teratoma (20%). Bleomycin chemotherapy was not associated with pulmonary complications or 90-day mortality. Patients receiving second-line chemotherapy followed by resection had significantly worse OS and PFS than patients receiving first-line chemotherapy followed by resection. On multivariable analysis, R1/R2 resection (HR, 3.92; P < 0.001) and increasing postoperative STMs (HR, 4.98; P < 0.001) were associated with shorter PFS; necrosis on pathology (HR, 0.42, P = 0.043) was associated with longer PFS.Conclusions: In patients with PMNSGCT undergoing resection, completeness of resection, postoperative pathology, and postoperative STMs were associated with PFS. Induction bleomycin was not associated with pulmonary complications or mortality in patients undergoing resection. Patients undergoing second-line chemotherapy followed by resection have a poor prognosis, with long-term survival of 22%.