Original articleGeneral thoracicThoracic Metastasectomy in Germ Cell Tumor Patients Treated With First-line Versus Salvage Therapy
Section snippets
Patient Selection
We performed a retrospective review of a prospectively maintained database of patients with primary testicular GCT (seminoma and NSGCT) who underwent thoracic metastasectomy at Memorial Sloan Kettering (MSK) between 1997 and 2019. Data collected included patient demographic information, diagnostic approaches, International Germ Cell Cancer Collaborative Group (IGCCCG) risk classification at diagnosis,10 preoperative chemotherapy regimens, STM (before chemotherapy and before and after surgery),
Preoperative Patient and Disease Characteristics
We identified 251 patients with testicular GCTs (4% seminoma and 96% NSGCT) who underwent postchemotherapy thoracic metastasectomy (60 salvage versus 191 first-line alone) (Table 1). Intrathoracic metastasis was identified at initial diagnosis in 237 patients (94%): 65% pulmonary only (n = 153), 10% mediastinum only (n = 24), and 25% pulmonary and mediastinum (n = 60). The NSGCT pathologic findings commonly demonstrated a mixed tumor (n = 165; 66%) composed of multiple NSGCT subtypes (teratoma,
Comment
This large contemporary study examined thoracic metastasectomy in patients with primary testicular GCT by chemotherapy exposure. Salvage patients had a more aggressive disease profile, were more likely to have increasing preoperative STM, and were 3-fold more likely to have residual viable malignancy. Even with resection of disease, 5-year PFS among salvage patients was 40%, compared with 69% for first-line patients. Our findings suggest that aggressive thoracic metastasectomy is warranted,
References (23)
- et al.
Multidisciplinary clinic approach improves overall survival outcomes of patients with metastatic germ-cell tumors
Ann Oncol
(2018) - et al.
A review of second-line chemotherapy and prognostic models for disseminated germ cell tumors
Hematol Oncol Clin North Am
(2011) - et al.
Salvage high-dose chemotherapy for germ cell tumors
Urol Oncol
(2015) - et al.
Surgical management of patients with advanced germ cell tumors following salvage chemotherapy: Memorial Sloan Kettering Cancer Center (MSKCC) experience
Urology
(2019) - et al.
Surgical salvage therapy for malignant intrathoracic metastases from nonseminomatous germ cell cancer of testicular origin: analysis of a single-institution experience
J Thorac Cardiovasc Surg
(2005) - et al.
Survival after resection for metastatic testicular nonseminomatous germ cell cancer to the lung or mediastinum
Ann Thorac Surg
(2011) - et al.
Nonseminomatous germ cell tumors: assessing the need for postchemotherapy contralateral pulmonary resection in patients with ipsilateral complete necrosis
J Thorac Cardiovasc Surg
(2009) - et al.
Medical treatment of advanced testicular cancer
JAMA
(2008) - et al.
Recent global trends in testicular cancer incidence and mortality
Medicine (Baltimore)
(2018) - et al.
Testicular cancer: a reflection on 50 years of discovery
J Clin Oncol
(2014)
AJCC Cancer Staging Manual
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