Cagini L, Nicholson A G, Horwich A, Goldstraw P, Pastorino U
Dipartimento di scienze chirurgiche, Università di Perugia, Italy.
Ann Oncol. 1998 Nov;9(11):1185-91. doi: 10.1023/a:1008491807858.
This study evaluated the results of thoracic metastasectomy for germ cell tumours to assess long term survival and identify prognostic factors.
A series of 141 consecutive patients who underwent resection of thoracic metastases at Royal Brompton Hospital were retrospectively reviewed. Kaplan-Meier estimates of survival were calculated for clinical variables related to primary tumour and thoracic metastases, using the Cox model for multivariate analysis.
Complete resection was achieved in 123 cases (87%); pathology showed viable malignant elements in 46 (32%), necrosis or fibrosis in 32, differentiated teratoma in 63. The overall survival was 77% at five years and 65% at 15 years, being significantly shorter in patients with malignant teratomatous elements (51% at five years, P = 0.0001) or incomplete resection (64% at five years, P = 0.019). At multivariate analysis these factors retained their prognostic value, with a relative risk of death of 5.7 for malignant teratomatous elements and 4.0 for incomplete resection. In addition, the Cox model revealed a 3.2 times higher risk of relapse in patients with malignant teratomatuos elements at the time of thoracic metastasectomy.
These data confirm the value of thoracic metastasectomy to asses pathological response and achieve permanent cure of chemoresistant disease.
本研究评估了生殖细胞肿瘤胸段转移瘤切除术的结果，以评估长期生存率并确定预后因素。
回顾性分析了皇家布朗普顿医院连续141例行胸段转移瘤切除术的患者。使用Cox模型进行多因素分析，计算与原发性肿瘤和胸段转移瘤相关的临床变量的Kaplan-Meier生存估计值。
123例（87%）实现了完全切除；病理显示46例（32%）有存活的恶性成分，32例有坏死或纤维化，63例为成熟畸胎瘤。5年总生存率为77%，15年为65%，有恶性畸胎瘤成分的患者（5年时为51%，P = 0.0001）或切除不完全的患者（5年时为64%，P = 0.019）的总生存率显著较低。在多因素分析中，这些因素保留了其预后价值，恶性畸胎瘤成分的死亡相对风险为5.7，切除不完全的为4.0。此外，Cox模型显示，在胸段转移瘤切除时，有恶性畸胎瘤成分的患者复发风险高3.2倍。
这些数据证实了胸段转移瘤切除术对于评估病理反应和实现化疗耐药性疾病的永久治愈的价值。
