Thoracic metastasectomy for germ cell tumours: Long term survival and prognostic factors

Background. This study evaluated the results of thoracic metastasectomy for germ cell tumours to assess long term survival and identify prognostic fac tors. Patients and methods: A series of 141 consecutive patients who underwent re section of thoracic metastases at Royal Brompton Hospital were retrospectiv ely reviewed. Kaplan-Meier estimates of survival were calculated for clinic al variables related to primary tumour and thoracic metastases, using the C ox model for multivariate analysis. Results: Complete resection was achieved in 123 cases (87%); pathology show ed viable malignant elements in 46 (32%), necrosis or fibrosis in 32, diffe rentiated teratoma in 63. The overall survival was 77% at five years and 65 % at 15 years, being significantly shorter in patients with malignant terat omatous elements (51% at five years, P = 0.0001) or incomplete resection (6 4% at five years, P = 0.019). At multivariate analysis these factors retain ed their prognostic value, with a relative risk of death of 5.7 for maligna nt 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 mal ignant teratomatuos elements at the time of thoracic metastasectomy. Conclusions. These data confirm the value of thoracic metastasectomy to ass es pathological response and achieve permanent cure of chemoresistant disea se.