title: A 25-year single institution experience with surgery for primary mediastinal nonseminomatous germ cell tumors.
abstract: BACKGROUND
  The treatment of primary mediastinal nonseminomatous germ cell tumors (PMNSGCT) with cisplatin-based chemotherapy, followed by surgical resection of residual disease, has been established. We reviewed our institution's 25-year experience in the cisplatin era to determine surgical risks and predictors of survival after surgery for PMNSGCT.
  
  
  METHODS
  A total of 158 patients (mean age, 29 +/- 8 years) who underwent postchemotherapy operations for PMNSGCT were reviewed and multiple variables analyzed.
  
  
  RESULTS
  Ten (6%) operative deaths occurred, nine of which were attributed to respiratory failure, and 26 (18%) patients experienced postoperative complications, including 9 with respiratory failure. None of 17 recent patients who received chemotherapy regimens that did not contain bleomycin experienced pulmonary complications (p = 0.12 vs patients who received bleomycin). Operative survivors were followed up a median of 34 months (range, 1 to 194 months). Multivariable analysis demonstrated that the postchemotherapy pathologic category of complete necrosis vs teratoma), persistent germ cell or nongerm cell cancer, and elevated serum tumor markers after operation were independently predictive of survival.
  
  
  CONCLUSIONS
  Operative risks for PMNSGCT appear to be improved with the use of chemotherapy regimens that do not contain bleomycin. Patients pathologically demonstrating complete tumor necrosis in the residual mass after chemotherapy have excellent long-term survival, with decreasing survival after resection of teratoma and persistent germ cell or nongerm cell cancer. Patients pathologically demonstrating persistent germ cell or nongerm cell cancer have poor but possible long-term survival, which justifies an aggressive surgical approach in patients who are deemed operable.
authors.affiliation: Department of Surgery, Cardiothoracic Division, Indiana University School of Medicine, Indianapolis, Indiana 46202, USA. kkesler@iupui.edu
authors.forename: Kenneth A
authors.initials: KA
authors.lastname: Kesler
authors.forename: Karen M
authors.initials: KM
authors.lastname: Rieger
authors.forename: Zane T
authors.initials: ZT
authors.lastname: Hammoud
authors.forename: Laura E
authors.initials: LE
authors.lastname: Kruter
authors.forename: Susan M
authors.initials: SM
authors.lastname: Perkins
authors.forename: Mark W
authors.initials: MW
authors.lastname: Turrentine
authors.forename: Bryan P
authors.initials: BP
authors.lastname: Schneider
authors.forename: Lawrence H
authors.initials: LH
authors.lastname: Einhorn
authors.forename: John W
authors.initials: JW
authors.lastname: Brown
mesh_terms: D000046:Academic Medical Centers; D000293:Adolescent; D000328:Adult; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use*; D017024:Chemotherapy, Adjuvant; D002648:Child; D002945:Cisplatin / Q000008:administration & dosage; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007196:Indiana; D008297:Male; D008479:Mediastinal Neoplasms / Q000188:drug therapy / Q000401:mortality* / Q000473:pathology / Q000601:surgery*; D015999:Multivariate Analysis; D009367:Neoplasm Staging; D009373:Neoplasms, Germ Cell and Embryonal / Q000188:drug therapy / Q000401:mortality* / Q000473:pathology / Q000601:surgery*; D011237:Predictive Value of Tests; D011336:Probability; D016016:Proportional Hazards Models; D012042:Registries; D012189:Retrospective Studies; D018570:Risk Assessment; D016019:Survival Analysis; D013908:Thoracotomy / Q000379:methods; D016896:Treatment Outcome
chemical_list: D002945:Cisplatin