Mediastinal metastases from testicular nonseminomatous germ cell tumors: Patterns of dissemination and predictors of long-term survival with surgery

Kenneth Kesler, Jo Ann Brooks, Karen Rieger, Naomi S. Fineberg, Lawrence Einhorn, John Brown, Joe B. Putnam, Joseph B. Shrager, Robert J. Ginsberg

Research output: Contribution to journalArticle

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Abstract

Objectives: The purpose of this study was to determine the pattern of mediastinal dissemination of nonseminomatous germ cell tumors of testicular origin and evaluate variables that may influence survival with mediastinal dissection in patients with metastatic nonseminomatous germ cell tumors. Methods: From 1981 to 2000, a total of 421 patients were seen at our institution for extirpation of residual lung or mediastinal disease after cisplatin-based chemotherapy for metastatic testicular nonseminomatous germ cell tumors. We reviewed 268 of these patients, with a mean age of 26.8 years, who required at least one surgical procedure to remove residual mediastinal disease. Pathologic types of resected residual mediastinal disease were necrosis (15%), teratoma (59%), persistent nonseminomatous germ cell cancer (15%), and non-germ cell carcinomatous degeneration (11%). Twelve variables were evaluated by univariate analyses, and four variables potentially statistically significant at P < .10 were subsequently entered into a Cox regression model. Results: All patients demonstrated metastases to the visceral mediastinum. Fewer patients also demonstrated metastases to the paravertebral sulcus or anterior compartments (16% and 7%, respectively). Overall 5- and 10-year survivals were 86% ± 2% and 74% ± 4%, respectively. According to multivariate analysis, diseaserelated survival was negatively influenced by an elevated preoperative β-human chorionic gonadotropin level (P = .028) and adverse pathologic characteristics of residual mediastinal disease (P = .006). Conclusions: Testicular nonseminomatous germ cell tumors follow a predictable pattern of mediastinal dissemination, primarily following the course of the thoracic duct and its major tributaries. Patients who require surgery to remove residual mediastinal disease after cisplatin-based chemotherapy for metastatic nonseminomatous germ cell tumors have good to excellent long-term survivals. These results justify an aggressive surgical approach, including multiple surgical procedures if clinically indicated.

Original languageEnglish
Pages (from-to)913-923
Number of pages11
JournalJournal of Thoracic and Cardiovascular Surgery
Volume125
Issue number4
DOIs
StatePublished - Apr 1 2003

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Mediastinal Diseases
Neoplasm Metastasis
Survival
Cisplatin
Drug Therapy
Thoracic Duct
Germ Cell and Embryonal Neoplasms
Teratoma
Mediastinum
Chorionic Gonadotropin
Proportional Hazards Models
Lung Diseases
Testicular Germ Cell Tumor
Nonseminomatous germ cell tumor
Dissection
Necrosis
Multivariate Analysis
Neoplasms

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine
  • Surgery

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Mediastinal metastases from testicular nonseminomatous germ cell tumors : Patterns of dissemination and predictors of long-term survival with surgery. / Kesler, Kenneth; Brooks, Jo Ann; Rieger, Karen; Fineberg, Naomi S.; Einhorn, Lawrence; Brown, John; Putnam, Joe B.; Shrager, Joseph B.; Ginsberg, Robert J.

In: Journal of Thoracic and Cardiovascular Surgery, Vol. 125, No. 4, 01.04.2003, p. 913-923.

Research output: Contribution to journalArticle

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title = "Mediastinal metastases from testicular nonseminomatous germ cell tumors: Patterns of dissemination and predictors of long-term survival with surgery",
abstract = "Objectives: The purpose of this study was to determine the pattern of mediastinal dissemination of nonseminomatous germ cell tumors of testicular origin and evaluate variables that may influence survival with mediastinal dissection in patients with metastatic nonseminomatous germ cell tumors. Methods: From 1981 to 2000, a total of 421 patients were seen at our institution for extirpation of residual lung or mediastinal disease after cisplatin-based chemotherapy for metastatic testicular nonseminomatous germ cell tumors. We reviewed 268 of these patients, with a mean age of 26.8 years, who required at least one surgical procedure to remove residual mediastinal disease. Pathologic types of resected residual mediastinal disease were necrosis (15{\%}), teratoma (59{\%}), persistent nonseminomatous germ cell cancer (15{\%}), and non-germ cell carcinomatous degeneration (11{\%}). Twelve variables were evaluated by univariate analyses, and four variables potentially statistically significant at P < .10 were subsequently entered into a Cox regression model. Results: All patients demonstrated metastases to the visceral mediastinum. Fewer patients also demonstrated metastases to the paravertebral sulcus or anterior compartments (16{\%} and 7{\%}, respectively). Overall 5- and 10-year survivals were 86{\%} ± 2{\%} and 74{\%} ± 4{\%}, respectively. According to multivariate analysis, diseaserelated survival was negatively influenced by an elevated preoperative β-human chorionic gonadotropin level (P = .028) and adverse pathologic characteristics of residual mediastinal disease (P = .006). Conclusions: Testicular nonseminomatous germ cell tumors follow a predictable pattern of mediastinal dissemination, primarily following the course of the thoracic duct and its major tributaries. Patients who require surgery to remove residual mediastinal disease after cisplatin-based chemotherapy for metastatic nonseminomatous germ cell tumors have good to excellent long-term survivals. These results justify an aggressive surgical approach, including multiple surgical procedures if clinically indicated.",
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T1 - Mediastinal metastases from testicular nonseminomatous germ cell tumors

T2 - Patterns of dissemination and predictors of long-term survival with surgery

AU - Kesler, Kenneth

AU - Brooks, Jo Ann

AU - Rieger, Karen

AU - Fineberg, Naomi S.

AU - Einhorn, Lawrence

AU - Brown, John

AU - Putnam, Joe B.

AU - Shrager, Joseph B.

AU - Ginsberg, Robert J.

PY - 2003/4/1

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N2 - Objectives: The purpose of this study was to determine the pattern of mediastinal dissemination of nonseminomatous germ cell tumors of testicular origin and evaluate variables that may influence survival with mediastinal dissection in patients with metastatic nonseminomatous germ cell tumors. Methods: From 1981 to 2000, a total of 421 patients were seen at our institution for extirpation of residual lung or mediastinal disease after cisplatin-based chemotherapy for metastatic testicular nonseminomatous germ cell tumors. We reviewed 268 of these patients, with a mean age of 26.8 years, who required at least one surgical procedure to remove residual mediastinal disease. Pathologic types of resected residual mediastinal disease were necrosis (15%), teratoma (59%), persistent nonseminomatous germ cell cancer (15%), and non-germ cell carcinomatous degeneration (11%). Twelve variables were evaluated by univariate analyses, and four variables potentially statistically significant at P < .10 were subsequently entered into a Cox regression model. Results: All patients demonstrated metastases to the visceral mediastinum. Fewer patients also demonstrated metastases to the paravertebral sulcus or anterior compartments (16% and 7%, respectively). Overall 5- and 10-year survivals were 86% ± 2% and 74% ± 4%, respectively. According to multivariate analysis, diseaserelated survival was negatively influenced by an elevated preoperative β-human chorionic gonadotropin level (P = .028) and adverse pathologic characteristics of residual mediastinal disease (P = .006). Conclusions: Testicular nonseminomatous germ cell tumors follow a predictable pattern of mediastinal dissemination, primarily following the course of the thoracic duct and its major tributaries. Patients who require surgery to remove residual mediastinal disease after cisplatin-based chemotherapy for metastatic nonseminomatous germ cell tumors have good to excellent long-term survivals. These results justify an aggressive surgical approach, including multiple surgical procedures if clinically indicated.

AB - Objectives: The purpose of this study was to determine the pattern of mediastinal dissemination of nonseminomatous germ cell tumors of testicular origin and evaluate variables that may influence survival with mediastinal dissection in patients with metastatic nonseminomatous germ cell tumors. Methods: From 1981 to 2000, a total of 421 patients were seen at our institution for extirpation of residual lung or mediastinal disease after cisplatin-based chemotherapy for metastatic testicular nonseminomatous germ cell tumors. We reviewed 268 of these patients, with a mean age of 26.8 years, who required at least one surgical procedure to remove residual mediastinal disease. Pathologic types of resected residual mediastinal disease were necrosis (15%), teratoma (59%), persistent nonseminomatous germ cell cancer (15%), and non-germ cell carcinomatous degeneration (11%). Twelve variables were evaluated by univariate analyses, and four variables potentially statistically significant at P < .10 were subsequently entered into a Cox regression model. Results: All patients demonstrated metastases to the visceral mediastinum. Fewer patients also demonstrated metastases to the paravertebral sulcus or anterior compartments (16% and 7%, respectively). Overall 5- and 10-year survivals were 86% ± 2% and 74% ± 4%, respectively. According to multivariate analysis, diseaserelated survival was negatively influenced by an elevated preoperative β-human chorionic gonadotropin level (P = .028) and adverse pathologic characteristics of residual mediastinal disease (P = .006). Conclusions: Testicular nonseminomatous germ cell tumors follow a predictable pattern of mediastinal dissemination, primarily following the course of the thoracic duct and its major tributaries. Patients who require surgery to remove residual mediastinal disease after cisplatin-based chemotherapy for metastatic nonseminomatous germ cell tumors have good to excellent long-term survivals. These results justify an aggressive surgical approach, including multiple surgical procedures if clinically indicated.

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