1. Pathologic concordance of resected metastatic nonseminomatous germ cell tumors in the chest.
- Author
-
Donahoe LL, Nason GJ, Bedard PL, Hansen AR, Jewett MAS, Hamilton RJ, and de Perrot M
- Subjects
- Adult, Biopsy, Chemotherapy, Adjuvant, Clinical Decision-Making, Humans, Lung Neoplasms mortality, Lung Neoplasms secondary, Male, Mediastinal Neoplasms mortality, Mediastinal Neoplasms secondary, Neoadjuvant Therapy, Neoplasm, Residual, Neoplasms, Germ Cell and Embryonal mortality, Neoplasms, Germ Cell and Embryonal secondary, Patient Selection, Predictive Value of Tests, Retrospective Studies, Testicular Neoplasms mortality, Testicular Neoplasms pathology, Time Factors, Treatment Outcome, Young Adult, Lung Neoplasms surgery, Mediastinal Neoplasms surgery, Metastasectomy adverse effects, Metastasectomy mortality, Neoplasms, Germ Cell and Embryonal surgery, Testicular Neoplasms surgery, Thoracic Surgical Procedures adverse effects, Thoracic Surgical Procedures mortality
- Abstract
Objective: Men with metastatic nonseminomatous germ cell tumors (NSGCTs) often present with residual chest tumors after chemotherapy. We examined the pathologic concordance of intrathoracic disease and outcomes based on the worst pathology of disease resected at first thoracic surgery., Methods: A retrospective analysis was performed of consecutive patients undergoing thoracic resection for metastatic NSGCT in our institution between 2005 and 2018., Results: Eighty-nine patients (all men) were included. The median age was 29 years (interquartile range [IQR], 23-35 years). Primary sites were testis (n = 84; 94.4%) and retroperitoneum (n = 5; 5.6%). Eighty-seven patients received chemotherapy before undergoing surgery. Nineteen patients (21.3%; group 1) had malignancy resected at first surgery (OR1), and the other 70 patients had benign disease at OR1 (78.7%; group 2). Concordant pathology between lungs was 85.2% in group 1 and 91% in group 2, and between lung and mediastinum was 50% in group 1 and 72.7% in group 2. Despite no teratoma at OR1, 3 patients (15.8%) in group 2 had resection of teratoma (n = 2) or malignancy (n = 1) at future surgery. After a mean follow-up of 65.5 months (IQR, 23.1-89.2 months) for group 1 and 47.7 months (IQR, 13.0-75.1 months) for group 2, overall survival was significantly worse for group 1 (68.4% vs 92.9%; P = .03)., Conclusions: The wide range of pathology resected in patients with intrathoracic NSGCT metastases requires careful decision making regarding treatment. Pathologic concordance between lungs is better than that between lung and mediastinum in patients with intrathoracic NSGCT metastases. Aggressive surgical management should be considered for all residual disease due to the low concordance between sites and the potential for excellent long-term survival even in patients with chemotherapy-refractory disease., (Crown Copyright © 2020. Published by Elsevier Inc. All rights reserved.)
- Published
- 2021
- Full Text
- View/download PDF