title: Thoracic metastasectomy for germ cell tumours: long term survival and prognostic factors.
abstract: BACKGROUND
  This study evaluated the results of thoracic metastasectomy for germ cell tumours to assess long term survival and identify prognostic factors.
  
  
  METHODS
  A series of 141 consecutive patients who underwent resection of thoracic metastases at Royal Brompton Hospital were retrospectively reviewed. Kaplan-Meier estimates of survival were calculated for clinical variables related to primary tumour and thoracic metastases, using the Cox model for multivariate analysis.
  
  
  RESULTS
  Complete resection was achieved in 123 cases (87%); pathology showed viable malignant elements in 46 (32%), necrosis or fibrosis in 32, differentiated teratoma in 63. The overall survival was 77% at five years and 65% at 15 years, being significantly shorter in patients with malignant teratomatous elements (51% at five years, P = 0.0001) or incomplete resection (64% at five years, P = 0.019). At multivariate analysis these factors retained their prognostic value, with a relative risk of death of 5.7 for malignant teratomatous elements and 4.0 for incomplete resection. In addition, the Cox model revealed a 3.2 times higher risk of relapse in patients with malignant teratomatuos elements at the time of thoracic metastasectomy.
  
  
  CONCLUSIONS
  These data confirm the value of thoracic metastasectomy to asses pathological response and achieve permanent cure of chemoresistant disease.
authors.affiliation: Dipartimento di scienze chirurgiche, Università di Perugia, Italy.
authors.forename: L
authors.initials: L
authors.lastname: Cagini
authors.forename: A G
authors.initials: AG
authors.lastname: Nicholson
authors.forename: A
authors.initials: A
authors.lastname: Horwich
authors.forename: P
authors.initials: P
authors.lastname: Goldstraw
authors.forename: U
authors.initials: U
authors.lastname: Pastorino
mesh_terms: D000328:Adult; D018237:Germinoma / Q000556:secondary* / Q000601:surgery; D006801:Humans; D008175:Lung Neoplasms / Q000556:secondary / Q000601:surgery; D008297:Male; D015999:Multivariate Analysis; D011379:Prognosis; D012189:Retrospective Studies; D016019:Survival Analysis; D013736:Testicular Neoplasms / Q000188:drug therapy / Q000473:pathology* / Q000601:surgery; D013899:Thoracic Neoplasms / Q000556:secondary* / Q000601:surgery