Sharp David S, Carver Brett S, Eggener Scott E, Kondagunta G Varuni, Motzer Robert J, Bosl George J, Sheinfeld Joel
Department of Urology, Memorial Sloan-Kettering Cancer Center, 353 E 68th St, New York, NY 10021, USA.
J Clin Oncol. 2008 Dec 1;26(34):5524-9. doi: 10.1200/JCO.2007.15.7453. Epub 2008 Oct 20.
Late relapse (LR) of germ cell tumor (GCT) is a well recognized entity associated with poor survival. We report on our experience with LR and determine predictors of survival.
From 1990 to 2004, 75 patients were managed for LR of GCT at our institution. Clinical and pathologic parameters were reviewed. Estimates of cancer-specific survival were generated using the Kaplan-Meier method, and a Cox proportional hazards model was used to assess potential predictors of outcome.
The median time to LR was 6.9 years (range, 2.1 to 37.7 years). Overall, 56 patients (75%) had LR in the retroperitoneum, including 25 (93%) of 27 patients initially managed without retroperitoneal lymph node dissection. The 5-year cancer-specific survival (CSS) was 60% (95% CI, 46% to 71%). Patients who underwent complete surgical resection at time of LR (n = 45) had a 5-year CSS of 79% versus 36% for patients without complete resection (n = 30; P < .0001). The 5-year CSS for chemotherapy-naive patients was significantly greater than patients with a prior history of chemotherapy as part of their initial management (5-year CSS, 93% v 49%, respectively). In multivariable analysis of pretreatment parameters available at the time of LR, the presence of symptoms (hazard ratio [HR] = 4.9) and multifocal disease (HR = 3.0) were associated with an inferior CSS.
The data suggest that meticulous control of the retroperitoneum is critical to prevent LR in the retroperitoneum. In multivariable analysis, patients with a symptomatic presentation and those with multifocal disease have a significantly decreased survival. Survival is greatly improved if complete surgical excision of disease is attained.
生殖细胞肿瘤（GCT）的晚期复发（LR）是一种公认的与生存不良相关的情况。我们报告我们在LR方面的经验并确定生存的预测因素。
1990年至2004年，我们机构对75例GCT晚期复发患者进行了治疗。回顾了临床和病理参数。使用Kaplan-Meier方法生成癌症特异性生存估计值，并使用Cox比例风险模型评估结果的潜在预测因素。
LR的中位时间为6.9年（范围2.1至37.7年）。总体而言，56例患者（75%）在腹膜后复发，其中27例最初未进行腹膜后淋巴结清扫的患者中有25例（93%）复发。5年癌症特异性生存率（CSS）为60%（95%CI，46%至71%）。LR时接受完整手术切除的患者（n = 45）5年CSS为79%，而未进行完整切除的患者（n = 30）为36%（P <.0001）。未接受过化疗的患者5年CSS显著高于初始治疗时曾接受过化疗的患者（5年CSS分别为93%和49%）。在对LR时可用的预处理参数进行多变量分析时，症状的存在（风险比[HR]=4.9）和多灶性疾病（HR = 3.0）与较差的CSS相关。
数据表明，对腹膜后的精心控制对于预防腹膜后LR至关重要。在多变量分析中,有症状表现的患者和多灶性疾病患者的生存率显著降低。如果能实现疾病的完整手术切除，生存率会大大提高。
