Residual tumor resection after high-dose chemotherapy in patients with relapsed or refractory germ cell cancer
Residual tumor resection after high-dose chemotherapy in patients with relapsed or refractory germ cell cancer
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DOI：
10.1200/jco.2004.07.124
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发表时间：
2004-09-15
影响因子：
45.3
通讯作者：
Beyer, J
中科院分区：
文献类型：
--
作者：
Rick, O;Bokemeyer, C;Beyer, J
目的评估大剂量化疗（HDCT）后进行残余肿瘤切除术在复发性或难治性生殖细胞肿瘤（GCT）患者中的作用。患者和方法1987年7月至1999年10月期间，对57例曾接受HDCT治疗复发或难治性GCT并获得部分缓解的患者进行化疗后残留肿瘤切除术。57例患者中有52例（91%）实现了残留肿块的完全切除，这些患者均无疾病; 57例患者中有5例（9%）切除不完全。57例患者中有39例（68%）进行了单部位切除，其余18例（32%）需要在两个或多个残留肿瘤部位进行干预。57例患者中有22例（38%）发现坏死，9例（16%）发现成熟畸胎瘤伴或不伴坏死，26例（46%）发现存活癌伴或不伴额外坏死或成熟畸胎瘤。26例患者中有22例（85%）的存活癌由残留生殖细胞或未分化癌组成，其余4例患者的组织学类型为其他非GCT。与坏死和/或成熟畸胎瘤患者相比，即使所有癌症都被完全切除，存活癌症患者的术后结局也明显较差。直径大于2 cm的肺部病变是生存癌的唯一预测变量在单因素analysis.Conclusion应尝试切除所有残留肿瘤的复发或难治性GCT和部分缓解后HDCT患者。(C)2004年，美国临床肿瘤学会。
Purpose To assess the role of residual tumor resection performed after high-dose chemotherapy (HDCT) in patients with relapsed or refractory germ cell tumors (GCT).Patients and Methods Between July 1987 and October 1999, postchemotherapy resections of residual tumors were performed in 57 patients who had been treated with HDCT for relapsed or refractory GCT and who had achieved a partial remission to this treatment.Results Complete resections of residual masses were achieved in 52 (91%) of 57 patients who were rendered disease free; in five (9%) of 57 patients, the resections were incomplete. Resection of a single site was performed in 39 (68%) of 57 patients, and the remaining 18 (32%) of 57 patients required interventions at two or more residual tumor sites. Necrosis was found in 22 (38%) of 57 patients, mature teratoma with or without necrosis was found in nine (16%) of 57 patients, and viable cancer with or without additional necrosis or mature teratoma was found in 26 (46%) of 57 patients. Viable cancer consisted either of residual germ cell or undifferentiated cancer in 22 (85%) of 26 patients, with additional non-GCT histologies in the remaining four patients. Patients with viable cancer had a significantly inferior outcome after surgery compared with patients with necrosis and/or mature teratoma even if all cancer was completely resected. Pulmonary lesions with a diameter of more than 2 cm were the only predictive variable for viable cancer in univariate analysis.Conclusion Resections of all residual tumors should be attempted in patients with relapsed or refractory GCT and partial remissions after HDCT. (C) 2004 by American Society of Clinical Oncology.