PROGNOSIS AFTER RESECTION OF RESIDUAL MASSES FOLLOWING CHEMOTHERAPY FOR METASTATIC NONSEMINOMATOUS TESTICULAR CANCER - A MULTIVARIATE-ANALYSIS

Following chemotherapy for metastatic nonseminomatous testicular cance r, 86 patients with normal serum markers AFP and HCG underwent resecti on of residual tumour masses (63 laparotomy, 11 thoracotomy, 12 both). Prognostic factors for relapse and survival were analysed with Kaplan -Meier curves and Cox regression analysis. Putative prognostic factors included age, the primary histology, prechemotherapy level of the tum our markers AFP and HCG, the extent of disease (lymph nodes, lung and hepatic metastases) before and after chemotherapy, the histology of th e resected material and the completeness of the surgical procedure. El even patients relapsed during follow-up (median 47 months), accounting for a 5 year relapse free percentage of 87.4%. Adverse prognostic fac tors were (1) prechemotherapy level of HCG (greater-than-or-equal-to 1 0,000 IU l-1; (2) incomplete resection; and (3) the extent of disease, especially of lung metastases (prechemotherapy number less-than-or-eq ual-to 3,4- 19, greater-than-or-equal-to 20; or size after chemotherap y > 1 cm; or presence of any residual lung metastasis after chemothera py without residual abdominal metastases). The histology found at rese ction was not associated with the risk of relapse, which might be expl ained by the effectiveness of postresection chemotherapy, which in the majority of these patients was a salvage regimen rather than two furt her cycles of the initial cytostatics. A good and a poor risk group we re formed, based on HCG level and completeness of resection. The effec t of salvage chemotherapy after resection of viable cancer cells needs further investigation.