title: Survival after resection for metastatic testicular nonseminomatous germ cell cancer to the lung or mediastinum.
abstract: BACKGROUND
  Since the advent of cisplatin-based chemotherapy, nonseminomatous germ cell tumors (NSGCT) have been considered one of the most curable solid neoplasms and a model for multimodality cancer therapy. We undertook an institutional review of testicular NSGCT patients who underwent operations to remove lung or mediastinal metastases after chemotherapy in the cisplatin era to determine outcomes.
  
  
  METHODS
  From 1980 to 2006, 431 patients underwent 640 postchemotherapy surgical procedures to remove lung (n = 159, 36.8%), mediastinal (n = 136, 31.6%), or both lung and mediastinal (n = 136, 31.6%) metastases within 2 years of chemotherapy. Multiple variables potentially predictive of survival were analyzed.
  
  
  RESULTS
  The overall median survival was 23.4 years, with 295 (68%) patients alive and well after an average follow-up of 5.6 years. There was no survival difference in patients who underwent removal of lung or mediastinal metastases. Pathologic categories of resected residual disease were necrosis (21.5%), teratoma (52.7%), persistent NSGCT (15.0%), and degenerative non-germ cell cancer (10.1%). Multivariable analysis identified older age at time of diagnosis (p = 0.001), non-germ cell cancer in testes specimen (p = 0.004), and pathology of residual disease (p < 0.001) as significantly predictive of survival.
  
  
  CONCLUSIONS
  Patients who undergo resection of residual lung or mediastinal disease for metastatic testicular NSGCT as a planned approach after cisplatin-based chemotherapy have overall excellent long-term survival. Survival is equivalent comparing hematogenous and lymphatic routes of metastases but depends on the pathology of the resected disease. These results justify an aggressive surgical approach, particularly to remove residual teratoma in the lung or mediastinum after chemotherapy, including multiple surgical procedures if necessary.
authors: Department of Surgery, Cardiothoracic Division, Indiana University Melvin and Bren Simon Cancer Center, Indianapolis, Indiana 46202, USA. kkesler@iupui.edu
authors: Kenneth A
authors: KA
authors: Kesler
authors: Laura E
authors: LE
authors: Kruter
authors: Susan M
authors: SM
authors: Perkins
authors: Karen M
authors: KM
authors: Rieger
authors: Katherine J
authors: KJ
authors: Sullivan
authors: Matthew L
authors: ML
authors: Runyan
authors: John W
authors: JW
authors: Brown
authors: Lawrence H
authors: LH
authors: Einhorn
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D002648:Child; D006801:Humans; D008175:Lung Neoplasms / Q000401:mortality* / Q000556:secondary* / Q000628:therapy; D008297:Male; D008479:Mediastinal Neoplasms / Q000401:mortality* / Q000556:secondary* / Q000628:therapy; D008875:Middle Aged; D009373:Neoplasms, Germ Cell and Embryonal / Q000401:mortality / Q000556:secondary / Q000628:therapy; D012189:Retrospective Studies; D015996:Survival Rate; D013736:Testicular Neoplasms / Q000401:mortality* / Q000473:pathology* / Q000628:therapy; D055815:Young Adult