Gerl A, Clemm C, Schmeller N, Hartenstein R, Lamerz R, Wilmanns W
Department of Internal Medicine III, Klinikum Grosshadern of the University of Munich, Germany.
Br J Cancer. 1995 Oct;72(4):1026-32. doi: 10.1038/bjc.1995.456.
Long-term outcome of salvage treatment was reviewed in 67 unselected male patients relapsing during or after their primary cisplatin-based chemotherapy for metastatic germ cell tumours. Seven patients underwent only surgery and/or radiotherapy as curatively intended salvage treatment. Thirty-five patients (52%) had a complete or partial response to salvage treatment, 20 (57%) of whom relapsed again. With a median follow-up of 90 months (range 3-143 months) 20 patients (30%) are alive with no evidence of disease, 15 continuously disease-free and five currently disease-free. The 5 year survival from start of salvage treatment is 37% for the group as a whole. Multivariate analysis identified age < or = 35 years, complete response to primary treatment and a relapse-free interval > 3 months as independent predictors of favourable outcome of salvage treatment. A group of patients with these good-risk factors (42%) had a 5 year survival of 72% compared with the remaining patients (58%) with a 5 year survival of only 11%. Whereas patients with good-risk features may be adequately managed by conventional salvage treatment, the remaining patients carry a very poor prognosis and require innovative and more aggressive approaches.
对67例在以顺铂为主的转移性生殖细胞肿瘤一线化疗期间或之后复发的男性患者进行了挽救性治疗的长期疗效评估。7例患者仅接受了旨在治愈的手术和/或放疗作为挽救性治疗。35例患者（52%）对挽救性治疗有完全或部分反应，其中20例（57%）再次复发。中位随访时间为90个月（范围3 - 143个月），20例患者（30%）存活且无疾病证据，15例持续无病生存，5例目前无病生存。整个组从挽救性治疗开始的5年生存率为37%。多因素分析确定年龄≤35岁、对一线治疗完全缓解以及无复发生存期>3个月是挽救性治疗良好预后的独立预测因素。一组具有这些良好风险因素的患者（42%）5年生存率为72%，而其余患者（58%）5年生存率仅为11%。具有良好风险特征的患者可能通过传统的挽救性治疗得到充分管理，而其余患者预后很差，需要创新且更积极的治疗方法。
