Department of Thoracic and Vascular Surgery and Heart-Lung Transplantation, Hôpital Marie-Lannelongue, Le Plessis Robinson, France.
Eur J Cardiothorac Surg. 2012 Jul;42(1):66-71; discussion 71. doi: 10.1093/ejcts/ezr252. Epub 2012 Jan 20.
Platinum-based chemotherapy followed by surgical resection of residual masses has become the standard treatment of patients with primary mediastinal non-seminomatous germ cell tumours (NSGCTs). Persistent serum tumour marker (STM) elevation after chemotherapy usually indicates a poor prognosis. We retrospectively assessed surgical outcomes in patients with high STM levels after chemotherapy for primary mediastinal NSGCT.
Between 1983 and 2010, residual tumour excision was performed in 21 patients, 20 men and one woman with a median age of 30 years (range: 19-49 years), with primary mediastinal NSGCTs and high STM levels after platinum-based chemotherapy, followed by second-line chemotherapy in 11 patients.
Alpha-fetoprotein was elevated in all 21 patients and β-human chorionic gonadotropin in three patients. Permanent histology demonstrated viable germ cell tumour (n=13), teratoma (n=3) or necrosis (n=5). After surgery, the STM levels returned to normal in 11 patients. Eight patients are alive with a median follow-up of 98 months. The 5-year survival rate was 36% and was not significantly affected by the use of preoperative second-line chemotherapy. At univariate analysis, only postoperative STM elevation and residual viable tumour, indicating incomplete resection, were significantly associated with lower survival (P=0.018 and P=0.04, respectively).
In patients with primary mediastinal NSGCTs and elevated post-chemotherapy STMs, surgery is warranted when complete resection is deemed feasible. In specialized oncology centres, this aggressive approach can provide a cure in some patients.
铂类化疗后切除残留肿瘤已成为原发性纵隔非精原细胞瘤生殖细胞肿瘤（NSGCT）患者的标准治疗方法。化疗后血清肿瘤标志物（STM）持续升高通常预示预后不良。我们回顾性评估了化疗后 STM 水平升高的原发性纵隔 NSGCT 患者的手术结果。
1983 年至 2010 年间，21 例患者接受了残留肿瘤切除术，均为男性，1 例女性，中位年龄 30 岁（范围：19-49 岁），均为原发性纵隔 NSGCT 且铂类化疗后 STM 水平升高，其中 11 例患者接受了二线化疗。
21 例患者 AFP 均升高，3 例β-HCG 升高。永久性组织学检查显示活的生殖细胞瘤（n=13）、畸胎瘤（n=3）或坏死（n=5）。手术后，11 例患者的 STM 水平恢复正常。8 例患者存活，中位随访时间为 98 个月。5 年生存率为 36%，术前二线化疗的使用未显著影响生存率。单因素分析显示，仅术后 STM 升高和残留活肿瘤（提示切除不完全）与较低的生存率显著相关（P=0.018 和 P=0.04）。
对于原发性纵隔 NSGCT 且化疗后 STM 升高的患者，当认为完全切除可行时，应进行手术。在专业肿瘤中心，这种积极的方法可以为一些患者提供治愈机会。
