Kang Chang Hyun, Kim Young Tae, Jheon Sang-Hoon, Sung Sook-whan, Kim Joo Hyun
Department of Thoracic and Cardiovascular Surgery, Cancer Research Institute, Seoul National University Hospital, Seoul, South Korea.
Ann Thorac Surg. 2008 Feb;85(2):379-84. doi: 10.1016/j.athoracsur.2007.09.011.
The aim of this study was to evaluate the role of surgical treatment for mediastinal nonseminomatous germ cell tumors (MNSGCT) and identify the factors of long-term survival.
A retrospective review of the medical records of patients with primary MNSGCT who registered at our institute between 1988 and 2005 was performed. Of 29 patients who presented with primary MNSGCT, 21 patients (72.4%) underwent curative resection and were included in this study.
All patients were male and symptomatic at presentation. Mean patient age was 24.4 years (range, 9 to 53 years). Three different regimens were used for preoperative chemotherapy, and 14 patients (66.7%) achieved partial response, 4 (19.0%) had stable disease, and 2 (9.5%) had progressive disease. Complete en bloc excision was possible in 16 patients (76.2%). The most common cause of incomplete resection was great vessel invasion (n = 3). Concomitantly resected organs were lung in 13 patients (61.9%) and superior vena cava in 5 (23.8%). Viable germ cell tumor was identified in pathology specimens in 12 (57.1%), total necrosis in 7 (33.3%), and remnant teratoma in 2 (9.5%). Five-year overall and disease-free survivals were 63.6% and 61.1%. Risk factors for poor overall survival by multivariate analysis were beta-human chorionic gonadotrophin (beta-HCG) elevation at initial diagnosis (p = 0.02) and incomplete resection (p = 0.002).
Surgical resection of MNSGCT after chemotherapy showed favorable long-term survival. Complete resection should be performed to achieve long-term survival. An elevated beta-HCG level at initial diagnosis was associated with a poor prognosis despite multimodality therapy.
本研究的目的是评估手术治疗在纵隔非精原细胞瘤性生殖细胞肿瘤（MNSGCT）中的作用，并确定长期生存的因素。
对1988年至2005年在我院登记的原发性MNSGCT患者的病历进行回顾性分析。29例原发性MNSGCT患者中，21例（72.4%）接受了根治性切除并纳入本研究。
所有患者均为男性，就诊时均有症状。患者平均年龄为24.4岁（范围9至53岁）。术前化疗采用三种不同方案，14例（66.7%）部分缓解，4例（19.0%）病情稳定，2例（9.5%）病情进展。16例（76.2%）患者能够完整整块切除。切除不完全的最常见原因是大血管侵犯（n = 3）。同期切除的器官中，13例（61.9%）为肺，5例（23.8%）为上腔静脉。病理标本中12例（57.1%）发现有活性的生殖细胞肿瘤，7例（33.3%）完全坏死，2例（9.5%）为残留畸胎瘤。五年总生存率和无病生存率分别为63.6%和61.1%。多因素分析显示，初始诊断时β-人绒毛膜促性腺激素（β-HCG）升高（p = 0.02）和切除不完全（p = 0.002）是总生存不良的危险因素。
化疗后手术切除MNSGCT显示出良好的长期生存率。应进行完整切除以实现长期生存。尽管采用了多模式治疗，但初始诊断时β-HCG水平升高与预后不良相关。
