Vuky J, Bains M, Bacik J, Higgins G, Bajorin D F, Mazumdar M, Bosl G J, Motzer R J
Genitourinary Oncology Service, Division of Solid Tumor Oncology, Department of Medicine, Memorial Sloan-Kettering Cancer Center, New York, NY, USA.
J Clin Oncol. 2001 Feb 1;19(3):682-8. doi: 10.1200/JCO.2001.19.3.682.
To evaluate the role of postchemotherapy surgery in patients with nonseminomatous germ cell tumors arising from the anterior mediastinum.
Thirty-two patients with nonseminoma arising from a mediastinal primary site were treated on a clinical trial at our center, and they underwent postchemotherapy surgery. The results of postchemotherapy surgical resection, frequency of viable tumor found during postchemotherapy surgery, and prognostic factors for survival were assessed.
Complete resection of all gross residual disease was achieved in 27 patients (84%). Histologic analysis of resected residua postchemotherapy revealed viable tumor in 66%, teratoma in 22%, and necrosis in 12% of the specimens. Viable tumor included embryonal carcinoma, choriocarcinoma, yolk sac carcinoma, seminoma, and teratoma with malignant transformation to nongerm cell histology (eg, sarcoma). Clinical characteristics associated with a shorter survival after surgery included the presence of viable tumor in a resected specimen (P =.003) and more than one site resected during surgery (P =.06). There were no statistically significant differences in survival for patients who underwent surgical resection with normal markers compared with patients with elevated serum tumor markers (P =.33). A trend toward shorter survival was found in patients with increasing tumor markers before surgery compared with patients with normal and declining serum tumor markers (P =.09).
Surgical resection of residual mass after chemotherapy plays an integral role in the management of patients with primary mediastinal nonseminoma. Teratoma and viable tumor were found in the majority of resected residua after chemotherapy. Because patients who undergo conventional salvage chemotherapy programs rarely achieve long-term disease-free status, selected patients with elevated markers after chemotherapy are considered candidates for surgical resection.
评估化疗后手术在源于前纵隔的非精原性生殖细胞肿瘤患者中的作用。
32例源于纵隔原发部位的非精原细胞瘤患者在本中心进行临床试验，并接受了化疗后手术。评估化疗后手术切除结果、化疗后手术中发现存活肿瘤的频率以及生存的预后因素。
27例患者（84%）实现了所有大体残留病灶的完全切除。化疗后切除残端的组织学分析显示，66%的标本中有存活肿瘤，22%为畸胎瘤，12%为坏死。存活肿瘤包括胚胎癌、绒毛膜癌、卵黄囊癌、精原细胞瘤以及向非生殖细胞组织学恶性转化的畸胎瘤（如肉瘤）。与术后生存期较短相关的临床特征包括切除标本中存在存活肿瘤（P = 0.003）以及手术中切除部位超过一处（P = 0.06）。与血清肿瘤标志物升高的患者相比，手术切除后标志物正常的患者在生存方面无统计学显著差异（P = 0.33）。与术前血清肿瘤标志物正常和下降的患者相比，术前肿瘤标志物升高的患者有生存期缩短的趋势（P = 0.09）。
化疗后残留肿块的手术切除在原发性纵隔非精原细胞瘤患者的治疗中起着不可或缺的作用。化疗后大多数切除的残端中发现了畸胎瘤和存活肿瘤。由于接受传统挽救性化疗方案的患者很少能达到长期无病状态，因此化疗后标志物升高的特定患者被视为手术切除的候选者。
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