Thoracic Surgery Department, Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo (HCFMUSP), São Paulo, SP, Brazil.
Thoracic Surgical Oncology, Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo (HCFMUSP), São Paulo, SP, Brazil.
Clinics (Sao Paulo). 2024 Feb 14;79:100338. doi: 10.1016/j.clinsp.2024.100338. eCollection 2024.
Almost 20 % of patients with Non-Seminomatous Germinative Cell Tumors (NSGCT) will require intrathoracic metastasectomy after chemotherapy. The authors aim to determine their long-term survival rates.
Retrospective study including patients with NSGCT and intrathoracic metastasis after systemic therapy from January 2011 to June 2022. Treatment outcomes and overall survival were analyzed with the Kaplan-Meier method.
Thirty-seven male patients were included with a median age of 31.8 years. Six presented with synchronous mediastinum and lung metastasis, nine had only lung, and 22 had mediastinal metastasis. Over half had retroperitoneal lymph node metastasis. Twenty-two had dissimilar pathologies, with a discordance rate of 62 %. Teratoma and embryonal carcinoma were the prevalent primary tumor types, 40.5 % each, while teratoma was predominant (70.3 %) in the metastasis group. Thoracotomy was the main surgical approach (39.2 %) followed by VATS (37.2 %), cervico-sternotomy (9.8 %), sternotomy (5.8 %), and clamshell (3.9 %). Lung resection was performed in 40.5 % of cases. Overall, 10-year survival rates were 94.3 % with no surgical-related mortality.
Multimodality treatment with systemic therapy followed by radical surgery offers a high cure rate to patients with intrathoracic metastatic testicular germ cell tumors.
约 20%的非精原细胞瘤生殖细胞肿瘤（NSGCT）患者在化疗后需要进行胸腔内转移灶切除术。作者旨在确定其长期生存率。
回顾性研究纳入了 2011 年 1 月至 2022 年 6 月期间接受全身治疗后出现 NSGCT 合并胸腔内转移的患者。采用 Kaplan-Meier 法分析治疗结果和总生存率。
共纳入 37 例男性患者，中位年龄为 31.8 岁。6 例患者同时存在纵隔和肺部转移，9 例仅存在肺部转移，22 例存在纵隔转移。超过一半的患者存在腹膜后淋巴结转移。22 例存在不同的病理类型，不符合率为 62%。畸胎瘤和胚胎癌是最常见的原发性肿瘤类型，各占 40.5%，而转移组中以畸胎瘤为主（70.3%）。主要的手术方式为开胸术（39.2%），其次为胸腔镜手术（37.2%）、颈胸骨切开术（9.8%）、胸骨切开术（5.8%）和蛤壳式胸骨切开术（3.9%）。40.5%的患者进行了肺切除术。总体而言，10 年生存率为 94.3%，无手术相关死亡。
全身治疗联合根治性手术的多模态治疗为胸腔内转移性睾丸生殖细胞肿瘤患者提供了较高的治愈率。
