All authors: Indiana University School of Medicine, Indianapolis, IN.
J Clin Oncol. 2018 Oct 10;36(29):2950-2954. doi: 10.1200/JCO.18.00431. Epub 2018 Aug 29.
Three cycles of bleomycin, etoposide, and cisplatin (BEP × 3) or four cycles of etoposide and cisplatin (EP × 4) are first-line chemotherapy regimens for men with International Germ Cell Cancer Collaborative Group (IGCCCG) good-risk germ cell tumors (GCTs). We determined whether inclusion of bleomycin affected pulmonary and operative morbidity after postchemotherapy retroperitoneal lymph node dissection (PC-RPLND).
We queried our database to identify IGCCCG good-risk patients who received BEP × 3 or EP × 4 induction chemotherapy before PC-RPLND from 2006 to 2016. Patients who received combination regimens were excluded. The primary outcomes of interest were pulmonary morbidity (prolonged intubation, reintubation, supplemental oxygen use, intensive care unit stay) and operative morbidity (operative time, length of stay, concomitant procedures, estimated blood loss).
We analyzed 234 patients (191 BEP × 3 v 43 EP × 4). All patients were extubated immediately after the operation. None were reintubated or discharged on oxygen. Two patients in each cohort required an intensive care unit stay for nonpulmonary reasons. Patients treated with BEP required shorter use of supplemental oxygen (0.99 v 1.63 days; P = .005). No significant differences were found in preoperative mass size ( P = .42) or concomitant surgeries ( P = .58). Operative time was significantly shorter (131 v 170 minutes; P < .01), and estimated blood loss was considerably less (194 v 226 mL; P < .01) in patients treated with BEP. Length of stay was shorter in patients treated with BEP (3.3 v 3.9 days; P < .01).
In a modern surgical cohort, the inclusion of bleomycin does not seem to influence pulmonary morbidity, operative difficulty, or nonpulmonary postoperative complications after PC-RPLND in men with IGCCCG good-risk GST.
博来霉素、依托泊苷和顺铂（BEP×3）三个周期或依托泊苷和顺铂（EP×4）四个周期是国际生殖细胞癌症协作组（IGCCCG）低危生殖细胞肿瘤（GCT）患者的一线化疗方案。我们确定了博来霉素的加入是否会影响化疗后腹膜后淋巴结清扫术（PC-RPLND）后的肺部和手术发病率。
我们查询了数据库，以确定 2006 年至 2016 年期间接受 BEP×3 或 EP×4 诱导化疗后行 PC-RPLND 的 IGCCCG 低危患者。排除接受联合方案的患者。主要观察指标为肺部发病率（长时间插管、重新插管、吸氧、重症监护病房停留）和手术发病率（手术时间、住院时间、同时进行的手术、估计失血量）。
我们分析了 234 例患者（191 例 BEP×3 与 43 例 EP×4）。所有患者术后立即拔管。无重新插管或吸氧出院者。两个队列各有 2 例患者因非肺部原因入住重症监护病房。接受 BEP 治疗的患者需要补充氧气的时间更短（0.99 与 1.63 天；P=0.005）。术前肿块大小（P=0.42）或同时进行的手术（P=0.58）无显著差异。接受 BEP 治疗的患者手术时间明显缩短（131 与 170 分钟；P<0.01），估计失血量明显减少（194 与 226 mL；P<0.01）。接受 BEP 治疗的患者住院时间较短（3.3 与 3.9 天；P<0.01）。
在现代手术队列中，博来霉素的加入似乎不会影响 IGCCCG 低危 GST 患者 PC-RPLND 后的肺部发病率、手术难度或非肺部术后并发症。
