Wood D P, Herr H W, Motzer R J, Reuter V, Sogani P C, Morse M J, Bosl G J
Urology Service (Department of Surgery), Memorial Sloan-Kettering Cancer Center, New York, New York 10021.
Cancer. 1992 Nov 1;70(9):2354-7. doi: 10.1002/1097-0142(19921101)70:9<2354::aid-cncr2820700924>3.0.co;2-u.
Chemorefractory metastatic germ cell tumors and elevated tumor markers generally indicate inoperable disease.
Solitary metastases were resected in 15 patients who had a nonseminomatous germ cell tumor and an elevated alpha-fetoprotein (AFP) and/or human chorionic gonadotropin (HCG) serum level after treatment with cisplatin-based chemotherapy. Patients underwent resection for a residual mass after chemotherapy or for a new solitary metastasis after achieving a complete response (CR) to salvage chemotherapy.
Seven patients were disease-free after surgical resection alone. All five patients with an elevated HCG level had a relapse after surgery compared with 3 of 10 patients with only an elevated AFP level. Only 4 of 10 patients with a retroperitoneal metastasis had a relapse after surgery compared with 4 of 5 patients with visceral disease. Eleven of 15 patients overall were disease-free after surgery and subsequent chemotherapy after a relapse.
Surgical resection of a solitary metastasis despite elevated serum tumor markers should be considered in patients who have not had a durable CR to cisplatin-based chemotherapy.
化疗难治性转移性生殖细胞肿瘤及肿瘤标志物升高通常提示疾病无法手术切除。
15例非精原性生殖细胞肿瘤患者在接受以顺铂为基础的化疗后，α-甲胎蛋白（AFP）和/或人绒毛膜促性腺激素（HCG）血清水平升高，对其孤立性转移灶进行了切除。患者在化疗后因残留肿块或在对挽救性化疗达到完全缓解（CR）后因新出现的孤立性转移灶而接受手术切除。
仅手术切除后，7例患者无疾病复发。所有5例HCG水平升高的患者术后均复发，而10例仅AFP水平升高的患者中有3例复发。10例腹膜后转移患者中仅4例术后复发，而5例内脏疾病患者中有4例复发。15例患者中，总体上有11例在术后及复发后接受后续化疗后无疾病复发。
对于未从以顺铂为基础的化疗中获得持久CR的患者，尽管血清肿瘤标志物升高，也应考虑对孤立性转移灶进行手术切除。
