纵隔非精原细胞性生殖细胞肿瘤患者的现代治疗结果。

Results of modern therapy for patients with mediastinal nonseminomatous germ cell tumors.

作者信息

Ganjoo K N, Rieger K M, Kesler K A, Sharma M, Heilman D K, Einhorn L H

机构信息

Division of Hematology/Oncology, Department of Medicine, Indiana University, Indianapolis, IN 46202, USA.

出版信息

Cancer. 2000 Mar 1;88(5):1051-6. doi: 10.1002/(sici)1097-0142(20000301)88:5<1051::aid-cncr15>3.0.co;2-r.

DOI:10.1002/(sici)1097-0142(20000301)88:5<1051::aid-cncr15>3.0.co;2-r

PMID:10699894

Abstract

BACKGROUND

The aim of this study was to determine the effects of independent prognostic variables, such as prechemotherapy tumor markers, the extent of disease at diagnosis, the tumor markers postchemotherapy (PC), and the pathology of the PC residual mass on the overall survival of patients with primary mediastinal nonseminomatous germ cell tumors (PMNSGCT).

METHODS

The authors undertook a retrospective review of 39 patients with PMNSGCT between 1983 and 1997 who received their initial chemotherapy at Indiana University and 36 additional patients referred for PC resection. All patients received chemotherapy based on the combination of cisplatin and etoposide. The median follow-up was 22 months (range, 12-144 months).

RESULTS

The prechemotherapy tumor markers did not affect overall survival. Extent of disease (mediastinal only vs. visceral metastases) was an important prognostic factor for survival in univariate analysis (P = 0.042). Sixty-two of 75 patients underwent PC resection of residual disease. Fifteen of the 62 patients achieved a CR with chemotherapy alone, as the PC resection revealed only necrosis. Fourteen of these 15 patients continuously had no evidence of disease (NED). Forty-seven of the 62 patients had NED with chemotherapy and PC resection, including 31 with teratoma and 16 with carcinoma. However, 11 of 31 with teratoma and 11 of 16 with carcinoma subsequently relapsed. Although 18 patients had elevated tumor markers at the time of PC resection, 6 of 18 had only necrosis and 4 had teratoma. The PC tumor markers did not affect survival. The pathology of the resected specimen was the most significant predictor of survival in multivariate analysis (P < 0.001).

CONCLUSIONS

Twenty-eight of 39 patients (71.8%) with PMNSGCT treated at Indiana University achieved NED status, but only 16 (41%) continuously had NED. Twenty of 36 (55.5%) referred for resection continuously had NED. Disease confined to the mediastinum and necrosis in the PC specimen were important prognostic factors for survival.

摘要

背景

本研究旨在确定独立预后变量，如化疗前肿瘤标志物、诊断时疾病范围、化疗后肿瘤标志物（PC）以及PC残留肿块的病理情况对原发性纵隔非精原细胞瘤（PMNSGCT）患者总生存期的影响。

方法

作者对1983年至1997年间在印第安纳大学接受初始化疗的39例PMNSGCT患者以及另外36例因PC切除而转诊的患者进行了回顾性研究。所有患者均接受基于顺铂和依托泊苷联合的化疗。中位随访时间为22个月（范围12 - 144个月）。

结果

化疗前肿瘤标志物不影响总生存期。疾病范围（仅纵隔受累与内脏转移）在单因素分析中是生存的重要预后因素（P = 0.042）。75例患者中有62例接受了PC残留疾病切除术。62例患者中有15例仅通过化疗达到完全缓解（CR），因为PC切除仅显示坏死。这15例患者中有14例持续无疾病证据（NED）。62例患者中有47例通过化疗和PC切除达到NED，包括31例畸胎瘤患者和16例癌患者。然而，31例畸胎瘤患者中有11例以及16例癌患者中有11例随后复发。尽管18例患者在PC切除时肿瘤标志物升高，但18例中有6例仅为坏死，4例为畸胎瘤。PC肿瘤标志物不影响生存。在多因素分析中，切除标本的病理情况是生存的最显著预测因素（P < 0.001）。