OUTCOME ANALYSIS AFTER POSTCHEMOTHERAPY SURGERY IN PATIENTS WITH NONSEMINOMATOUS GERM-CELL TUMORS

Background: The goal of the study was to analyse long-term outcome aft er post-chemotherapy surgery in male patients with non-seminomatous ge rm cell tumours (NSGCT). Patients and methods: We reviewed the charts of 111 patients with metastatic NSGCT treated at a single institution from 1979 to 1993 who underwent post-chemotherapy resection of residua l masses after normalisation of tumour markers. The prognostic relevan ce of the extent of tumour residuals, the comprehensiveness of surgery and the histology at resection was analysed. Results: Thirteen patien ts (12%) harboured viable cancer, and 46 patients (41%) mature teratom a at post-chemotherapy surgery. Only seven (54%) of the 13 patients wi th viable cancer remained continuously disease-free. Incomplete surger y predicted an impaired outcome (62% vs. 86% survival), although only one recurrence was observed at a site of an incompletely resected mass . Moreover, a progression-free interval less than or equal to 3 months after post-chemotherapy surgery was correlated with worse subsequent survival (p = 0.0001). Conclusions. Post-chemotherapy surgery remains an essential part of the treatment for metastatic NSGCT. Resection of viable cancer and mature teratoma is of therapeutic benefit. Viable ca ncer at surgery defines the need for further chemotherapy.