title: Multimodality treatment of patients with liver metastases from germ cell tumors: the role of surgery.
abstract: BACKGROUND
  The presence of liver metastases represents an independent poor risk prognostic factor for survival in patients with germ cell tumors.
  
  
  METHODS
  The clinical files of 37 patients who had undergone liver resection for the treatment of disseminated germ cell tumors were reviewed to define the indications for resection of residual liver metastases after chemotherapy in patients with germ cell tumors. The histologic patterns of primary tumor and residual disease were compared. The prognostic factors for survival were studied by univariate analysis.
  
  
  RESULTS
  All but 2 of 37 patients underwent complete resection. One patient died of postoperative complications. Thirteen complications occurred in 10 patients. Twelve patients had active residual tumor, 7 patients had mature teratoma, and 18 patients had only necrosis on histologic examination. Twenty-three of 37 patients (62%) were alive with no evidence of disease after a median follow-up of 66 months (range, 31-134 months). Three prognostic factors were found to be significant in the univariate analysis for unfavorable outcome: the presence of pure embryonal carcinoma in the primary tumor, liver metastases measuring > 30 mm in greatest dimension at the time of surgery, and the presence of viable, active residual disease.
  
  
  CONCLUSIONS
  Because it is impossible to determine the histologic pattern of residual liver masses after chemotherapy with current imaging tools and percutaneous biopsy, patient selection for liver surgery may be undertaken according to the size of residual liver masses. Patients with masses that measure < or = 10 mm in greatest dimension should be considered for close follow-up, because they have a high probability of necrosis and are at low risk for malignant disease. Male patients with masses that measure > or = 30 mm in greatest dimension represent a high-risk group of patients who are not likely to benefit from liver surgery. Only male patients with masses that measure 10-29 mm in greatest dimension and all female patients with masses that measure > 10 mm in greatest dimension should be considered for liver resection.
authors.affiliation: Department of Surgery, Centre Léon Bérard 28, Rue Laënnec, 69373 Lyon Cedex 08, France. rivoire@lyon.fnclcc.fr
authors.forename: M
authors.initials: M
authors.lastname: Rivoire
authors.forename: D
authors.initials: D
authors.lastname: Elias
authors.forename: F
authors.initials: F
authors.lastname: De Cian
authors.forename: P
authors.initials: P
authors.lastname: Kaemmerlen
authors.forename: C
authors.initials: C
authors.lastname: Théodore
authors.forename: J P
authors.initials: JP
authors.lastname: Droz
mesh_terms: D000293:Adolescent; D000328:Adult; D003131:Combined Modality Therapy; D005260:Female; D018237:Germinoma / Q000401:mortality / Q000473:pathology / Q000556:secondary*; D006801:Humans; D008113:Liver Neoplasms / Q000473:pathology / Q000556:secondary* / Q000601:surgery; D008297:Male; D008875:Middle Aged; D011182:Postoperative Care; D011379:Prognosis; D012189:Retrospective Studies; D016896:Treatment Outcome