Division of Cardiothoracic Surgery, Department of Surgery, Indiana University Melvin and Bren Simon Cancer Center, Indianapolis, Ind.
Division of Cardiothoracic Surgery, Department of Surgery, Indiana University Melvin and Bren Simon Cancer Center, Indianapolis, Ind.
J Thorac Cardiovasc Surg. 2021 Jun;161(6):1947-1959.e1. doi: 10.1016/j.jtcvs.2020.01.118. Epub 2020 Apr 22.
Treatment of primary mediastinal nonseminomatous germ cell tumors involves cisplatin-based chemotherapy followed by surgery to remove residual disease. We undertook a study to determine short and long-term outcomes.
A retrospective analysis of patients with primary mediastinal nonseminomatous germ cell tumors who underwent surgery at our institution from 1982 to 2017 was performed.
A total of 255 patients (mean age, 29.2 years) were identified. Acute respiratory distress syndrome occurred postoperatively in 27 patients (10.9%), which was responsible for all 11 (4.3%) postoperative deaths. Of patients who developed acute respiratory distress syndrome, more patients received bleomycin-containing chemotherapy (25 out of 169; 14.8%) than non-bleomycin regimens (2 out of 77; 2.6%) (P = .004). With respect to variables independently predictive of long-term survival, evidence of choriocarcinoma before chemotherapy (n = 12) was determined to be an adverse factor (P = .006). In contrast, biopsy-proven elements of seminoma (n = 34) were predictive of improved survival (P = .04). The worst pathology identified in the residual mediastinal mass after chemotherapy was necrosis in 61 patients (25.0%), teratoma in 84 patients (34.4%), and malignant (persistent germ cell or non-germ cell cancer) in 97 patients (39.8%), which influenced overall survival (P < .001). Additionally, teratoma with stromal atypia (n = 18) demonstrated decreased survival compared with teratoma without atypia (n = 66; P = .031). Patients with malignancy involving >50% of the residual mass (n = 47) had a 2.3-fold increased risk of death compared with ≤50% malignancy (n = 45; P = .008). Finally, elevated postoperative serum tumor markers (n = 40) was significantly predictive of adverse survival (P < .001).
In the treatment of primary mediastinal nonseminomatous germ cell tumors, avoiding bleomycin-containing chemotherapy is important. Pre- and postchemotherapy pathology and postoperative serum tumor markers are independent predictors of long-term survival.
原发性纵隔非精原细胞瘤生殖细胞肿瘤的治疗包括基于顺铂的化疗，然后进行手术切除残留疾病。我们进行了一项研究以确定短期和长期结果。
对 1982 年至 2017 年在我院接受手术治疗的原发性纵隔非精原细胞瘤生殖细胞肿瘤患者进行回顾性分析。
共确定了 255 名患者（平均年龄 29.2 岁）。27 名患者（10.9%）术后发生急性呼吸窘迫综合征，这是所有 11 名（4.3%）术后死亡的原因。在发生急性呼吸窘迫综合征的患者中，接受含博来霉素化疗的患者多于非博来霉素方案（25 例[14.8%]比 77 例[2.6%]）（P=0.004）。在独立预测长期生存的变量方面，化疗前存在绒毛膜癌（n=12）被确定为不良因素（P=0.006）。相比之下，活检证实的精原细胞瘤成分（n=34）是生存改善的预测因素（P=0.04）。化疗后纵隔残余肿块中最严重的病理为坏死（61 例，25.0%）、畸胎瘤（84 例，34.4%）和恶性（持续性生殖细胞或非生殖细胞癌）（97 例，39.8%），这影响了总体生存（P<0.001）。此外，伴间质异型性的畸胎瘤（n=18）与无异型性的畸胎瘤（n=66）相比，生存时间缩短（P=0.031）。与残余肿瘤中恶性肿瘤比例≤50%（n=45）相比，恶性肿瘤比例>50%（n=47）的患者死亡风险增加 2.3 倍（P=0.008）。最后，术后血清肿瘤标志物升高（n=40）显著预测不良生存（P<0.001）。
在原发性纵隔非精原细胞瘤生殖细胞肿瘤的治疗中，避免含博来霉素的化疗很重要。化疗前后的病理学和术后血清肿瘤标志物是长期生存的独立预测因素。
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