Primary mediastinal nonseminomatous germ cell tumors: the influence of postchemotherapy pathology on long-term survival after surgery.
OBJECTIVE
The treatment of nonseminomatous germ cell tumors with cisplatin-based chemotherapy followed by aggressive surgical resection of residual disease is one of the most successful models for multimodality cancer therapy. We reviewed the case histories of 91 patients treated at our institution from 1981 to 1998 with primary mediastinal nonseminomatous germ cell tumors to evaluate variables that may influence survival after surgery.


METHODS
Twelve of the 91 patients did not undergo postchemotherapy resection because of progressive disease. Seventy-nine of them underwent 82 thoracic surgical procedures and are the basis of this review. The majority (71/75) had elevated serum tumor markers, 75% (n = 50) of which returned to normal levels after first- or second-line chemotherapy.


RESULTS
There were 3 operative deaths and 1 late death, attributed to pulmonary complications. Twenty-four patients died of recurrent disease and 3 of leukemia, for an overall survival of 61% after an average follow-up of 48 months. The pathologic findings of complete tumor necrosis (n = 19) and benign teratoma (n = 28) in the surgical specimen predicted excellent and good long-term survival, respectively, which was statistically better than that of patients having persistent nonseminomatous germ cell tumors (n = 24) or carcinomatous/sarcomatous degeneration (n = 8).


CONCLUSIONS
Primary nonseminomatous germ cell tumors of the mediastinum can be cured with a multimodality therapy, particularly in the subset of patients with postchemotherapy pathologic findings of tumor necrosis and teratoma. Survival is poor but possible in patients with unfavorable pathologic findings after chemotherapy, currently justifying an aggressive surgical approach in patients with otherwise operable disease.
Kesler
K A
KA
Indiana University School of Medicine, Department of Surgery, Thoracic Division, Indianapolis, Indiana, USA. kkesler@iupui.edu
Rieger
K M
KM
Ganjoo
K N
KN
Sharma
M
M
Fineberg
N S
NS
Einhorn
L H
LH
Brown
J W
JW
D000293:Adolescent; D000328:Adult; D000970:Antineoplastic Agents / Q000008:administration & dosage; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use; D014408:Biomarkers, Tumor / Q000097:blood; D002277:Carcinoma / Q000473:pathology; D002423:Cause of Death; D017024:Chemotherapy, Adjuvant; D002648:Child; D002945:Cisplatin / Q000008:administration & dosage; D018450:Disease Progression; D005260:Female; D005500:Follow-Up Studies; D018237:Germinoma / Q000188:drug therapy / Q000473:pathology* / Q000601:surgery; D006801:Humans; D007938:Leukemia / Q000473:pathology; D008137:Longitudinal Studies; D008297:Male; D008479:Mediastinal Neoplasms / Q000188:drug therapy / Q000473:pathology* / Q000601:surgery; D008875:Middle Aged; D009336:Necrosis; D009364:Neoplasm Recurrence, Local / Q000473:pathology; D016609:Neoplasms, Second Primary / Q000473:pathology; D012189:Retrospective Studies; D012509:Sarcoma / Q000473:pathology; D015996:Survival Rate; D013724:Teratoma / Q000473:pathology; D016896:Treatment Outcome
D000970:Antineoplastic Agents; D014408:Biomarkers, Tumor; D002945:Cisplatin