The role of surgery in stage IIC and III nonseminomatous testicular cancer.
30 Patients with stage IIC and III nonseminomatous testicular cancer underwent surgery for residual tumor after induction chemotherapy (postinductive surgery). There were no operative deaths and surgical morbidity was not influenced by preoperative chemotherapy. A complete surgical remission was achieved in 9 of 15 patients with mediastinal or pulmonary deposits and in 6 of 12 patients with retroperitoneal metastases. Alphafetoprotein (AFP) levels over 10(4)ng/ml at diagnosis and persistently elevated AFP values preoperatively were associated with failure of surgery to achieve complete remission (p less than .05) and to achieve long-term survival even after surgical complete remission. Fifteen of 17 patients with radical surgery remained disease-free after a median follow-up of 33 months. Six of the 13 relapsing patients had elevated AFP levels prior to definitive surgery. In one patient a contralateral testicular cancer was diagnosed 60 months after postinductive surgery. Of the 17 disease-free survivors, 12 had no tumor, 4 had mature teratoma and only one patient had mature teratoma with malignant foci in the resected surgical specimen. We conclude that AFP levels at diagnosis, elevated AFP prior to definitive surgery, achievement of complete surgical remission and histology of residual tumor are important prognostic factors determining long-term survival in residual stage IIC and III nonseminomatous testicular cancer.
D000293:Adolescent; D000328:Adult; D003131:Combined Modality Therapy; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D009367:Neoplasm Staging; D013736:Testicular Neoplasms / Q000188:drug therapy / Q000401:mortality / Q000601:surgery*