Beck Stephen D W, Foster Richard S, Bihrle Richard, Einhorn Lawrence H, Donohue John P
Department of Urology, Indiana University School of Medicine, Indianapolis, IN 46202, USA.
J Clin Oncol. 2005 Sep 1;23(25):6149-56. doi: 10.1200/JCO.2005.11.684.
To evaluate the therapeutic benefit of postchemotherapy retroperitoneal lymph node dissection (PCRPLND) in patients with persistently elevated serum tumor markers.
One hundred fourteen patients with metastatic germ cell cancer with elevated serum tumor markers after first-line (50 patients) or second-line chemotherapy (64 patients) who underwent PCRPLND between 1977 and 2000 with a minimum follow-up of 2-years were included in this retrospective study.
The 5-year overall survival was 53.9%. Sixty-one patients (53.5%) are alive with a medium follow-up of 72 months. Fifty-three patients died of disease, with a medium time to death of 8.0 months. Mean preoperative serum alpha-fetoprotein (AFP) and beta-human chorionic gonadotropin (betaHCG) levels were 483 ng/mL and 555 mU/mL, respectively, with no difference in 5-year survival (P = .2). Retroperitoneal pathology revealed germ cell cancer in 53.5% of patients, teratoma in 34.2% of patients, and fibrosis in 12.2% of patients, with 5-year survival rates of 31.4%, 77.5%, and 85.7%, respectively (P < .0001). Predictors of retroperitoneal pathology included an increasing serum AFP or betaHCG, betaHCG more than 100 ng/mL, redo retroperitoneal lymph node dissection (RPLND), and second-line chemotherapy. Poor prognostic variables by multivariable analysis included betaHCG status, serum AFP level, redo RPLND, and germ cell cancer in the resected specimen.
A subset of patients with elevated serum tumor markers after chemotherapy is curable with surgery. The prognostic factors predictive of outcome in this analysis include an increasing betaHCG, serum AFP level, redo RPLND, and germ cell cancer in the resected specimen. These factors, along with clinical and surgical experience, should aid in determining the appropriate integration of surgery and chemotherapy in this population.
评估化疗后腹膜后淋巴结清扫术（PCRPLND）对血清肿瘤标志物持续升高患者的治疗益处。
本回顾性研究纳入了1977年至2000年间接受PCRPLND的114例转移性生殖细胞癌患者，这些患者在一线（50例）或二线化疗（64例）后血清肿瘤标志物升高，且随访时间至少为2年。
5年总生存率为53.9%。61例患者（53.5%）存活，中位随访时间为72个月。53例患者死于疾病，中位死亡时间为8.0个月。术前血清甲胎蛋白（AFP）和β-人绒毛膜促性腺激素（βHCG）的平均水平分别为483 ng/mL和555 mU/mL，5年生存率无差异（P = 0.2）。腹膜后病理显示，53.5%的患者为生殖细胞癌，34.2%的患者为畸胎瘤，12.2%的患者为纤维化，5年生存率分别为31.4%、77.5%和85.7%（P < 0.0001）。腹膜后病理的预测因素包括血清AFP或βHCG升高、βHCG超过100 ng/mL、再次腹膜后淋巴结清扫术（RPLND）和二线化疗。多变量分析显示，预后不良的变量包括βHCG状态、血清AFP水平、再次RPLND以及切除标本中的生殖细胞癌。
化疗后血清肿瘤标志物升高的部分患者可通过手术治愈。本分析中预测预后的因素包括βHCG升高、血清AFP水平、再次RPLND以及切除标本中的生殖细胞癌。这些因素，连同临床和手术经验，应有助于确定该人群中手术和化疗的适当联合应用。
