Salvage surgery of chemorefractory germ cell tumors with elevated tumor markers

Purpose: We evaluated the prognostic criteria for salvage surgery in patien ts with persistent marker elevation after chemotherapy for metastatic germ cell tumors. Materials and Methods: Of 125 men who underwent post-chemotherapeutic resec tion of residual tumors 30 had persistent marker elevation at surgery. This group was subdivided into 17 patients with no evidence of disease, 7 dead of disease and 6 others. Outcome analysis was performed in the subgroups wi th regard to preoperative and postoperative parameters. Mean followup was 1 20.3 months (range 1 to 228) after surgery. Results: Of the 30 patients 17 (57%) with persistently elevated tumor marke rs after chemotherapy were long-term survivors after salvage surgery. Overa ll persistent viable cancer and teratomatous elements were identified in 64 % and 11% of cases, respectively. Significantly more patients died of disea se who had a poor prognosis according to International Germ Cell Cancer Col laborative Group guidelines. Embryonal carcinoma was the predominant initia l histology in this group and residual disease was more often located at va rious sites, for example the viscera, with a lower chance of complete surgi cal resection. Marker status before surgery, and chemotherapeutic pretreatm ent and postoperative histological findings did not differ significantly in patients with no evidence of disease and those dead of disease. Conclusions: Salvage surgery results in long-term success in greater than 5 0% of patients. Complete resection is the most important single parameter f or a favorable outcome. Even patients with visceral metastasis benefit from surgery. Our data do not justify omitting surgery in certain subgroups.