Stenning S P, Parkinson M C, Fisher C, Mead G M, Cook P A, Fossa S D, Horwich A, Jones W G, Newlands E S, Oliver R T, Stenwig A E, Wilkinson P M
Medical Research Council Cancer Trials Office, Cambridge, United Kingdom.
Cancer. 1998 Oct 1;83(7):1409-19.
In a retrospective study that included a detailed histopathologic review, the clinicopathologic features of patients with germ cell tumors (GCT) and resectable residual masses after chemotherapy were assessed.
Histologic material from 153 patients was available for review. Recorded details included primary histologic diagnosis, location, size and number of metastases, marker levels before and after chemotherapy, and completeness of surgical excision. A median of seven histologic sections per resection were reviewed by two pathologists independently (and together when disagreement occurred). In each case, details were recorded regarding fibrosis, necrosis, hemorrhage, embryonal carcinoma (undifferentiated teratoma), yolk sac tumor, choriocarcinoma (trophoblastic tumor), differentiated teratoma (mature and immature), dysplasia in somatic tissues, and non- germ cell tumor (GCT) malignancies. The percentage of the sample that each of these components comprised was also estimated.
The median postchemotherapy follow-up time was 7 years, and 38 of 153 patients (25%) experienced disease progression. In a multivariate analysis, incomplete resection of all residual masses (in 38 patients) and the presence of malignant elements (in 23 patients) were independent risk factors for progression. In the subset of patients in whom all masses were completely resected, the presence of embryonal carcinoma (undifferentiated teratoma) was the single most significant risk factor for progression. Seven percent of patients had this factor, which was associated with a 2-year progression free survival rate of 12.5%, compared with 88.0% where this component was absent.
Progression free survival can be predicted well by the completeness of excision of residual masses and the presence of malignant germ cell elements. The latter confers a relatively poor prognosis even if all of these elements are completely resected.
在一项包含详细组织病理学回顾的回顾性研究中，对生殖细胞肿瘤（GCT）患者以及化疗后可切除残留肿块的临床病理特征进行了评估。
有153例患者的组织学材料可供回顾。记录的详细信息包括原发组织学诊断、位置、转移灶的大小和数量、化疗前后的标志物水平以及手术切除的完整性。两名病理学家独立对每次切除的组织学切片进行中位数为7片的回顾（意见不一致时共同回顾）。在每个病例中，记录有关纤维化、坏死、出血、胚胎性癌（未分化畸胎瘤）、卵黄囊瘤、绒毛膜癌（滋养层肿瘤）、分化型畸胎瘤（成熟和未成熟）、体细胞组织发育异常以及非生殖细胞肿瘤（GCT）恶性肿瘤的详细信息。还估计了这些成分各自在样本中所占的百分比。
化疗后的中位随访时间为7年，153例患者中有38例（25%）出现疾病进展。在多变量分析中，所有残留肿块切除不完全（38例患者）和存在恶性成分（23例患者）是进展的独立危险因素。在所有肿块均完全切除的患者亚组中，胚胎性癌（未分化畸胎瘤）的存在是进展的唯一最重要危险因素。7%的患者有此因素，其2年无进展生存率为12.5%，而不存在该成分的患者为88.0%。
残留肿块切除的完整性和恶性生殖细胞成分的存在可以很好地预测无进展生存期。即使所有这些成分都被完全切除，后者的预后也相对较差。
