Survival after resection for metastatic testicular nonseminomatous germ cell cancer to the lung or mediastinum

Kenneth Kesler, Laura E. Kruter, Susan Perkins, Karen Rieger, Katherine J. Sullivan, Matthew L. Runyan, John Brown, Lawrence Einhorn

Research output: Contribution to journalArticle

17 Citations (Scopus)

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.

Original languageEnglish
Pages (from-to)1085-1093
Number of pages9
JournalAnnals of Thoracic Surgery
Volume91
Issue number4
DOIs
StatePublished - Apr 2011

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Mediastinal Neoplasms
Germ Cell and Embryonal Neoplasms
Lung Neoplasms
Survival
Drug Therapy
Lung
Cisplatin
Teratoma
Neoplasm Metastasis
Mediastinal Diseases
Pathology
Lymphatic Metastasis
Neoplasms
Testicular Neoplasms
Mediastinum
Lung Diseases
Necrosis
Nonseminomatous germ cell tumor

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine
  • Surgery
  • Pulmonary and Respiratory Medicine

Cite this

Survival after resection for metastatic testicular nonseminomatous germ cell cancer to the lung or mediastinum. / Kesler, Kenneth; Kruter, Laura E.; Perkins, Susan; Rieger, Karen; Sullivan, Katherine J.; Runyan, Matthew L.; Brown, John; Einhorn, Lawrence.

In: Annals of Thoracic Surgery, Vol. 91, No. 4, 04.2011, p. 1085-1093.

Research output: Contribution to journalArticle

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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.",
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AU - Runyan, Matthew L.

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AB - 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.

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