Thoracic Metastasectomy in Germ Cell Tumor Patients Treated With First-line Versus Salvage Therapy
| Autor: | George J. Bosl, Gaetano Rocco, Manjit S. Bains, David R. Jones, Samuel Funt, Daniela Molena, Raul Caso, David Amar, Darren R. Feldman, Joel Sheinfeld, Victor E. Reuter, Gregory W. Fischer, Gregory D. Jones, Kay See Tan |
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| Rok vydání: | 2021 |
| Předmět: |
Adult
Male Pulmonary and Respiratory Medicine medicine.medical_specialty medicine.medical_treatment Salvage therapy 030204 cardiovascular system & hematology Gastroenterology Disease-Free Survival Article Young Adult 03 medical and health sciences 0302 clinical medicine Testicular Neoplasms Interquartile range Internal medicine Humans Medicine Neoplasm Metastasis Neoplasm Staging Retrospective Studies Salvage Therapy Chemotherapy business.industry Hazard ratio Metastasectomy Neoplasms Germ Cell and Embryonal Thoracic Surgical Procedures Prognosis medicine.disease Primary tumor 030228 respiratory system Surgery Lymph Nodes Teratoma Cardiology and Cardiovascular Medicine business Brain metastasis |
| Zdroj: | Ann Thorac Surg |
| ISSN: | 0003-4975 |
| Popis: | BACKGROUND Outcomes after thoracic metastasectomy in patients with testicular germ cell tumors (GCTs) who received first-line chemotherapy alone versus salvage chemotherapy remain unexplored. METHODS We conducted a retrospective review of patients who underwent thoracic metastasectomy for residual GCT between 1997 and 2019 at a single tertiary center. Factors associated with progression-free survival (PFS) and overall survival (OS) were assessed using multivariable Cox regression. RESULTS Of 251 patients, 191 received only first-line chemotherapy (76%) and 60 received salvage chemotherapy (24%). Median follow-up was 3.45 years (interquartile range, 1-7.93 years). Among first-line patients without teratoma in the primary tumor, with necrosis in the retroperitoneal nodes and normalized or decreasing serum tumor markers, 17 of 20 had intrathoracic necrosis (85%). Among first-line and salvage patients, respectively, 5-year OS was 93% (95% confidence interval [CI], 89%-98%) versus 63% (95% CI, 51%-78%; P < .001), and 5-year PFS was 69% (95% CI, 62%-77%) versus 40% (95% CI, 29%-56%; P < .001). On multivariable analysis, multiple lung lesions (hazard ratio [HR] = 3.01; 95% CI, 1.50-6.05; P = .002) and brain metastasis (HR = 4.51; 95% CI, 2.34-8.73; P < .001) at diagnosis, salvage chemotherapy (HR = 1.85; 95% CI, 1.10-3.13; P = .021), teratoma (HR = 2.68; 95% CI, 1.50-4.78; P = .001), and viable malignancy (HR = 4.34; 95% CI, 2.44-7.71; P < .001) were associated with worse PFS. CONCLUSIONS Although GCT patients treated with salvage chemotherapy followed by thoracic metastasectomy have more aggressive disease and poorer PFS, they can achieve encouraging OS. Our findings highlight the integral role of aggressive thoracic metastasectomy in the treatment of GCT patients with residual thoracic disease after first line-only or salvage chemotherapy. |
| Databáze: | OpenAIRE |
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