Postchemotherapy Residual Tumor Resection in Patients with Elevated Tumor Markers
| Autor: | Achim Lusch, Carolin Buddensieck, Yue Che, P. Albers, Andreas Hiester, C. Winter, Robert Große Siemer |
|---|---|
| Rok vydání: | 2022 |
| Předmět: |
Adult
Male medicine.medical_specialty Neoplasm Residual Urology medicine.medical_treatment Tumor resection Chorionic Gonadotropin Gastroenterology Human chorionic gonadotropin Testicular Neoplasms Internal medicine Antineoplastic Combined Chemotherapy Protocols Biomarkers Tumor medicine Humans Survival rate Aged Tumor marker Salvage Therapy Chemotherapy business.industry Cancer Middle Aged Neoplasms Germ Cell and Embryonal Prognosis medicine.disease Survival Rate alpha-Fetoproteins Germ cell tumors Teratoma business |
| Zdroj: | Journal of Urology. 207:617-626 |
| ISSN: | 1527-3792 0022-5347 |
| DOI: | 10.1097/ju.0000000000002270 |
| Popis: | Purpose The oncological benefit of postchemotherapy residual tumor resection (PC-RTR) in patients with germ cell tumors and elevated serum tumor markers (STMs) remains unclear. This analysis was performed to better define patients who benefit from surgery in this setting. Patients and methods Of 575 PC-RTR procedures (07/2008 - 07/2019), 153 were performed in patients with elevated STMs (human chorionic gonadotropin (s-HCG) >2.0 mIU/ml, alpha-fetoprotein (AFP) >7.0 µg/l), including 55 after first-line and 98 after second- or later-line chemotherapy. Results Viable cancer in the resected specimen was significantly more common in the salvage group than in the first-line group (48.98% vs. 16.36%, p=0.0001988) and was a predictor of survival in both groups. A preoperative serum level of AFP ≥30 µg/l was a significant predictor of viable cancer in the first-line and salvage groups (55.56% [p=0.0157] and 66.67% [p=0.0017], respectively). The overall relapse-free survival rate (22.7% and 50%, p=0.00032) and overall survival rate (37.8% and 65%, p=0.0059) were significantly worse in the salvage group than in the first-line group. A preoperative serum level of AFP ≥30 µg/l and viable cancer/teratoma found in the histological examination of the RTR specimens were significant predictors of relapse after first-line chemotherapy. Serum AFP ≥30 µg/l and HCG ≥20 mIU/ml were significant factors affecting survival in the first-line group. Conclusion Patients with AFP serum levels>30 µg/l and HCG ≥20 mIU/ml after first-line chemotherapy should receive salvage chemotherapy instead of surgery. After second- or later-line therapy, the prognosis of patients with elevated markers and surgery is poor regardless of the tumor marker levels. However, 38% of these patients are long-term survivors, which justifies PC-RTR in this setting. |
| Databáze: | OpenAIRE |
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