Thoracic Metastasectomy in Germ Cell Tumor Patients Treated With First-line Versus Salvage Therapy.
Adult
Disease-Free Survival
Humans
Lymph Nodes
/ pathology
Male
Metastasectomy
/ methods
Neoplasm Metastasis
Neoplasm Staging
/ methods
Neoplasms, Germ Cell and Embryonal
/ diagnosis
Prognosis
Retrospective Studies
Salvage Therapy
/ methods
Testicular Neoplasms
/ diagnosis
Thoracic Surgical Procedures
/ methods
Young Adult
Journal
The Annals of thoracic surgery
ISSN: 1552-6259
Titre abrégé: Ann Thorac Surg
Pays: Netherlands
ID NLM: 15030100R
Informations de publication
Date de publication:
04 2021
04 2021
Historique:
received:
16
03
2020
revised:
24
04
2020
accepted:
15
06
2020
pubmed:
4
9
2020
medline:
7
4
2021
entrez:
4
9
2020
Statut:
ppublish
Résumé
Outcomes after thoracic metastasectomy in patients with testicular germ cell tumors (GCTs) who received first-line chemotherapy alone versus salvage chemotherapy remain unexplored. We conducted a retrospective review of patients who underwent thoracic metastasectomy for residual GCT between 1997 and 2019 at a single tertiary center. Factors associated with progression-free survival (PFS) and overall survival (OS) were assessed using multivariable Cox regression. Of 251 patients, 191 received only first-line chemotherapy (76%) and 60 received salvage chemotherapy (24%). Median follow-up was 3.45 years (interquartile range, 1-7.93 years). Among first-line patients without teratoma in the primary tumor, with necrosis in the retroperitoneal nodes and normalized or decreasing serum tumor markers, 17 of 20 had intrathoracic necrosis (85%). Among first-line and salvage patients, respectively, 5-year OS was 93% (95% confidence interval [CI], 89%-98%) versus 63% (95% CI, 51%-78%; P < .001), and 5-year PFS was 69% (95% CI, 62%-77%) versus 40% (95% CI, 29%-56%; P < .001). On multivariable analysis, multiple lung lesions (hazard ratio [HR] = 3.01; 95% CI, 1.50-6.05; P = .002) and brain metastasis (HR = 4.51; 95% CI, 2.34-8.73; P < .001) at diagnosis, salvage chemotherapy (HR = 1.85; 95% CI, 1.10-3.13; P = .021), teratoma (HR = 2.68; 95% CI, 1.50-4.78; P = .001), and viable malignancy (HR = 4.34; 95% CI, 2.44-7.71; P < .001) were associated with worse PFS. Although GCT patients treated with salvage chemotherapy followed by thoracic metastasectomy have more aggressive disease and poorer PFS, they can achieve encouraging OS. Our findings highlight the integral role of aggressive thoracic metastasectomy in the treatment of GCT patients with residual thoracic disease after first line-only or salvage chemotherapy.
Sections du résumé
BACKGROUND
Outcomes after thoracic metastasectomy in patients with testicular germ cell tumors (GCTs) who received first-line chemotherapy alone versus salvage chemotherapy remain unexplored.
METHODS
We conducted a retrospective review of patients who underwent thoracic metastasectomy for residual GCT between 1997 and 2019 at a single tertiary center. Factors associated with progression-free survival (PFS) and overall survival (OS) were assessed using multivariable Cox regression.
RESULTS
Of 251 patients, 191 received only first-line chemotherapy (76%) and 60 received salvage chemotherapy (24%). Median follow-up was 3.45 years (interquartile range, 1-7.93 years). Among first-line patients without teratoma in the primary tumor, with necrosis in the retroperitoneal nodes and normalized or decreasing serum tumor markers, 17 of 20 had intrathoracic necrosis (85%). Among first-line and salvage patients, respectively, 5-year OS was 93% (95% confidence interval [CI], 89%-98%) versus 63% (95% CI, 51%-78%; P < .001), and 5-year PFS was 69% (95% CI, 62%-77%) versus 40% (95% CI, 29%-56%; P < .001). On multivariable analysis, multiple lung lesions (hazard ratio [HR] = 3.01; 95% CI, 1.50-6.05; P = .002) and brain metastasis (HR = 4.51; 95% CI, 2.34-8.73; P < .001) at diagnosis, salvage chemotherapy (HR = 1.85; 95% CI, 1.10-3.13; P = .021), teratoma (HR = 2.68; 95% CI, 1.50-4.78; P = .001), and viable malignancy (HR = 4.34; 95% CI, 2.44-7.71; P < .001) were associated with worse PFS.
CONCLUSIONS
Although GCT patients treated with salvage chemotherapy followed by thoracic metastasectomy have more aggressive disease and poorer PFS, they can achieve encouraging OS. Our findings highlight the integral role of aggressive thoracic metastasectomy in the treatment of GCT patients with residual thoracic disease after first line-only or salvage chemotherapy.
Identifiants
pubmed: 32882201
pii: S0003-4975(20)31421-1
doi: 10.1016/j.athoracsur.2020.06.072
pmc: PMC7914302
mid: NIHMS1625064
pii:
doi:
Types de publication
Journal Article
Research Support, N.I.H., Extramural
Research Support, Non-U.S. Gov't
Langues
eng
Sous-ensembles de citation
IM
Pagination
1141-1149Subventions
Organisme : NCI NIH HHS
ID : P30 CA008748
Pays : United States
Organisme : NCI NIH HHS
ID : R01 CA217169
Pays : United States
Organisme : NCI NIH HHS
ID : R01 CA240472
Pays : United States
Informations de copyright
Copyright © 2021 The Society of Thoracic Surgeons. Published by Elsevier Inc. All rights reserved.
Références
J Clin Oncol. 2014 Oct 1;32(28):3085-92
pubmed: 25024068
J Thorac Cardiovasc Surg. 2009 Feb;137(2):448-52
pubmed: 19185168
JAMA. 2008 Feb 13;299(6):672-84
pubmed: 18270356
J Natl Cancer Inst. 1999 May 19;91(10):839-46
pubmed: 10340903
Medicine (Baltimore). 2018 Sep;97(37):e12390
pubmed: 30213007
Ann Surg. 2004 Aug;240(2):205-13
pubmed: 15273542
Urol Oncol. 2015 Aug;33(8):355-62
pubmed: 25837842
J Urol. 1998 Jun;159(6):1833-5
pubmed: 9598470
Ann Surg. 2020 Jan 21;:
pubmed: 31977510
J Clin Oncol. 1997 Feb;15(2):594-603
pubmed: 9053482
Hematol Oncol Clin North Am. 2011 Jun;25(3):557-76, viii -ix
pubmed: 21570609
Urology. 2019 Feb;124:174-178
pubmed: 30296502
Cancer. 1997 Jan 15;79(2):345-55
pubmed: 9010108
Ann Thorac Surg. 2011 Apr;91(4):1085-93; discussion 1093
pubmed: 21440128
Ann Oncol. 2018 Feb 1;29(2):341-346
pubmed: 29140422
J Clin Oncol. 2019 Sep 10;37(26):2329-2337
pubmed: 31233353
J Thorac Cardiovasc Surg. 2005 Aug;130(2):408-15
pubmed: 16077406
J Clin Oncol. 2016 Nov 20;34(33):4000-4007
pubmed: 27646943
BJU Int. 2003 Apr;91(6):469-73
pubmed: 12656895
J Clin Oncol. 2004 Sep 15;22(18):3713-9
pubmed: 15365067
PLoS One. 2015 Dec 01;10(12):e0142846
pubmed: 26624623