title: Residual tumor size and IGCCCG risk classification predict additional vascular procedures in patients with germ cell tumors and residual tumor resection: a multicenter analysis of the German Testicular Cancer Study Group.
abstract: BACKGROUND
  Residual tumor resection (RTR) after chemotherapy in patients with advanced germ cell tumors (GCT) is an important part of the multimodal treatment. To provide a complete resection of residual tumor, additional surgical procedures are sometimes necessary. In particular, additional vascular interventions are high-risk procedures that require multidisciplinary planning and adequate resources to optimize outcome.
  
  
  OBJECTIVE
  The aim was to identify parameters that predict additional vascular procedures during RTR in GCT patients.
  
  
  METHODS
  A retrospective analysis was performed in 402 GCT patients who underwent 414 RTRs in 9 German Testicular Cancer Study Group (GTCSG) centers. Overall, 339 of 414 RTRs were evaluable with complete perioperative data sets.
  
  
  METHODS
  The RTR database was queried for additional vascular procedures (inferior vena cava [IVC] interventions, aortic prosthesis) and correlated to International Germ Cell Cancer Collaborative Group (IGCCCG) classification and residual tumor volume.
  
  
  CONCLUSIONS
  In 40 RTRs, major vascular procedures (23 IVC resections with or without prosthesis, 11 partial IVC resections, and 6 aortic prostheses) were performed. In univariate analysis, the necessity of IVC intervention was significantly correlated with IGCCCG (14.1% intermediate/poor vs 4.8% good; p=0.0047) and residual tumor size (3.7% size < 5 cm vs 17.9% size ≥ 5 cm; p < 0.0001). In multivariate analysis, IVC intervention was significantly associated with residual tumor size ≥ 5 cm (odds ratio [OR]: 4.61; p=0.0007). In a predictive model combining residual tumor size and IGCCCG classification, every fifth patient (20.4%) with a residual tumor size ≥ 5 cm and intermediate or poor prognosis needed an IVC intervention during RTR. The need for an aortic prosthesis showed no correlation to either IGCCCG (p=0.1811) or tumor size (p=0.0651).
  
  
  CONCLUSIONS
  The necessity for IVC intervention during RTR is correlated to residual tumor size and initial IGCCCG classification. Patients with high-volume residual tumors and intermediate or poor risk features must initially be identified as high-risk patients for vascular procedures and therefore should be referred to specialized surgical centers with the ad hoc possibility of vascular interventions.
authors.affiliation: Department of Urology, Düsseldorf University Hospital, Düsseldorf, Germany. christian.winter@med.uni-duesseldorf.de
authors.forename: Christian
authors.initials: C
authors.lastname: Winter
authors.forename: David
authors.initials: D
authors.lastname: Pfister
authors.forename: Jonas
authors.initials: J
authors.lastname: Busch
authors.forename: Cigdem
authors.initials: C
authors.lastname: Bingöl
authors.forename: Ulrich
authors.initials: U
authors.lastname: Ranft
authors.forename: Mark
authors.initials: M
authors.lastname: Schrader
authors.forename: Klaus-Peter
authors.initials: KP
authors.lastname: Dieckmann
authors.forename: Axel
authors.initials: A
authors.lastname: Heidenreich
authors.forename: Peter
authors.initials: P
authors.lastname: Albers
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D013504:Cardiovascular Surgical Procedures; D003131:Combined Modality Therapy; D005858:Germany; D006801:Humans; D008113:Liver Neoplasms / Q000188:drug therapy / Q000556:secondary / Q000601:surgery; D008297:Male; D008875:Middle Aged; D018365:Neoplasm, Residual; D011379:Prognosis; D019736:Prostheses and Implants; D012186:Retroperitoneal Neoplasms / Q000188:drug therapy / Q000401:mortality / Q000473:pathology / Q000601:surgery*; D012189:Retrospective Studies; D012306:Risk; D018239:Seminoma / Q000188:drug therapy / Q000401:mortality / Q000556:secondary / Q000601:surgery*; D013736:Testicular Neoplasms / Q000188:drug therapy / Q000401:mortality / Q000473:pathology / Q000601:surgery*; D016896:Treatment Outcome; D055815:Young Adult