Raul Caso1, Gregory D Jones1, Kay See Tan2, George J Bosl3, Samuel A Funt4, Joel Sheinfeld5, Victor E Reuter6, David Amar7, Gregory Fischer7, Daniela Molena1, Gaetano Rocco1, Manjit S Bains1, Darren R Feldman4, David R Jones8. 1. Thoracic Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, New York. 2. Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, New York. 3. Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York. 4. Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York; Weill Cornell Medicine, New York, New York. 5. Urology Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, New York. 6. Department of Pathology, Memorial Sloan Kettering Cancer Center, New York, New York. 7. Department of Anesthesiology and Critical Care Medicine, Memorial Sloan Kettering Cancer Center, New York, New York. 8. Thoracic Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, New York. Electronic address: jonesd2@mskcc.org.
Abstract
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.
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.
Authors: P G Tognoni; R S Foster; P McGraw; D Heilman; R Bihrle; R G Rowland; G R Wahle; L H Einhorn; J P Donohue; P G Tognini Journal: J Urol Date: 1998-06 Impact factor: 7.450
Authors: L Collette; R J Sylvester; S P Stenning; S D Fossa; G M Mead; R de Wit; P H de Mulder; N Neymark; E Lallemand; S B Kaye Journal: J Natl Cancer Inst Date: 1999-05-19 Impact factor: 13.506
Authors: Raul Caso; Gregory D Jones; Manjit S Bains; Meier Hsu; Kay See Tan; Darren R Feldman; Samuel A Funt; Victor E Reuter; George J Bosl; Deaglan McHugh; James Huang; Daniela Molena; David Amar; Gregory Fischer; Valerie W Rusch; David R Jones Journal: Ann Surg Date: 2021-12-01 Impact factor: 13.787