Advanced metastatic testicular cancer: the need for reporting results according to initial extent of disease

During an 8-year period 63 consecutive patients were treated for the first time for extensive metastatic nonseminomatous testicular cancer. Four patients did not respond sufficiently to chemotherapy to be considered surgical candidates, while 59 underwent surgical resection of retroperitoneal disease. Of these 59 patients 19 had concomitant wedge resection of associated pulmonary disease and 9 had a planned subsequent resection of residual pulmonary disease. Of the 63 patients 16 had stage B3 disease alone and 47 presented with pulmonary metastases associated with varying degrees of retroperitoneal disease. The most important determinant for survival was extent of pulmonary disease. Of 17 deaths 14 occurred among patients presenting with extensive pulmonary disease. Patients with minimal to moderate pulmonary disease have done well regardless of the extent of coexistent abdominal disease, 24 of 27 (89 per cent) remaining in sustained complete remission. Of 16 patients with massive palpable abdominal disease (B3) without coexistent pulmonary metastases 15 (94 per cent) survived free of tumor. The combination of extensive pulmonary and abdominal disease with or without liver involvement has a poor prognosis, with only 35 per cent of these patients remaining in sustained complete remission. Preoperative combination chemotherapy with platinum, vinblastine sulfate and bleomycin has improved survival free of tumor in this group compared to other combinations not including platinum (47 compared to 20 per cent) but the results in this selected group of patients are significantly worse than those seen for all other patients with lesser extent of disease. Tumor recurrence more than 9 months after achieving complete remission has not been noted during following to 10 years. A plea is made for cases of advanced disease (B3 and/or C) to be reported according to the extent of pulmonary disease as well as the associated abdominal disease, since analysis of these data reveals striking differences in patient survival, ranging from 100 to 35 per cent according to subgrouping.