title: Prediction of necrosis after chemotherapy of advanced germ cell tumors: results of a prospective multicenter trial of the German Testicular Cancer Study Group.
abstract: OBJECTIVE
  We evaluated the prognostic parameters of necrotic residual tumors after chemotherapy of advanced germ cell tumors to improve on the current indications for surgery.
  
  
  METHODS
  Between January 1996 and January 2000, in 8 centers of the German Testicular Cancer Study Group, preoperative parameters were assessed to predict necrosis in the residual tumors of 261 patients with retroperitoneal residual tumor resection after first (92%) and second line (8%) chemotherapy.
  
  
  RESULTS
  Of 232 evaluable patients 39 had pure seminoma and 5 had viable cancer (1 with seminoma) in the residual tumor. Of the remaining 193 patients with nonseminoma 35% had necrosis, 34% teratoma and 31% had viable carcinoma in the residual tumor. After multivariate analysis and exclusion of patients with seminoma, the 3 parameters independently predictive of necrosis were alpha-fetoprotein before chemotherapy less than 20 ng/ml, and tumor volume before and after chemotherapy. A mathematical model to predict necrosis yielded a test accuracy of 75%, a sensitivity to predict necrosis of 52% and a specificity of 87%.
  
  
  CONCLUSIONS
  Patients with pure seminoma should not undergo residual tumor resection because 97% of patients who received adequate chemotherapy were found to have no residual seminoma. In cases of nonseminoma alpha-fetoprotein values before chemotherapy less than 20 ng/ml and a high percentage of shrinkage during chemotherapy reliably predicted only 19% of cases of necrosis. Therefore, this model is clinically irrelevant and patients with minimal residual disease should undergo surgery. New methods are necessary to improve the preoperative selection of patients after chemotherapy.
authors.affiliation: Department of Urology, Bonn University, Germany. albers@klinikum-kassel.de
authors.forename: Peter
authors.initials: P
authors.lastname: Albers
authors.forename: Lothar
authors.initials: L
authors.lastname: Weissbach
authors.forename: Susanne
authors.initials: S
authors.lastname: Krege
authors.forename: Sabine
authors.initials: S
authors.lastname: Kliesch
authors.forename: Michael
authors.initials: M
authors.lastname: Hartmann
authors.forename: Axel
authors.initials: A
authors.lastname: Heidenreich
authors.forename: Peter
authors.initials: P
authors.lastname: Walz
authors.forename: Markus
authors.initials: M
authors.lastname: Kuczyk
authors.forename: Rolf
authors.initials: R
authors.lastname: Fimmers
mesh_terms: D018237:Germinoma / Q000188:drug therapy* / Q000473:pathology*; D006801:Humans; D008297:Male; D009336:Necrosis; D009367:Neoplasm Staging; D018365:Neoplasm, Residual; D011379:Prognosis; D011446:Prospective Studies; D012186:Retroperitoneal Neoplasms / Q000473:pathology; D013736:Testicular Neoplasms / Q000188:drug therapy* / Q000473:pathology*