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Thoracic metastasectomy for germ cell tumours: long term survival and prognostic factors
L Cagini1, A G Nicholson, A Horwich
1Dipartimento di scienze chirurgiche, Università di Perugia, Italy.
Background:
This study evaluated the results of thoracic metastasectomy for germ cell tumours to assess long term survival and identify prognostic factors.
Patients And Methods:
A series of 141 consecutive patients who underwent resection of thoracic metastases at Royal Brompton Hospital were retrospectively reviewed. Kaplan-Meier estimates of survival were calculated for clinical variables related to primary tumour and thoracic metastases, using the Cox model for multivariate analysis.
Results:
Complete resection was achieved in 123 cases (87%); pathology showed viable malignant elements in 46 (32%), necrosis or fibrosis in 32, differentiated teratoma in 63. The overall survival was 77% at five years and 65% at 15 years, being significantly shorter in patients with malignant teratomatous elements (51% at five years, P = 0.0001) or incomplete resection (64% at five years, P = 0.019). At multivariate analysis these factors retained their prognostic value, with a relative risk of death of 5.7 for malignant teratomatous elements and 4.0 for incomplete resection. In addition, the Cox model revealed a 3.2 times higher risk of relapse in patients with malignant teratomatuos elements at the time of thoracic metastasectomy.
Conclusions:
These data confirm the value of thoracic metastasectomy to asses pathological response and achieve permanent cure of chemoresistant disease.
