Multimodality treatment of patients with liver metastases from germ cell tumors - The role of surgery

Background. The presence of liver metastases represents an independent poor risk prognostic factor for survival in patients with germ cell tumors. Methods. The clinical files of 37 patients who had undergone liver resectio n for the treatment of disseminated germ cell tumors were reviewed to defin e the indications for resection of residual liver metastases after chemothe rapy in patients with germ cell tumors. The histologic patterns of primary tumor and residual disease were compared. The prognostic factors for surviv al were studied by univariate analysis. Results. All but 2 of 37 patients underwent complete resection. One patient died of postoperative complications. Thirteen complications occurred in 10 patients. Twelve patients had active residual tumor, 7 patients had mature teratoma, and 18 patients had only necrosis on histologic examination. Twe nty-three of 37 patients (62%) were alive with no evidence of disease after a median follow-up of 66 months (range, 31-134 months). Three prognostic f actors were found to be significant in the univariate analysis for unfavora ble outcome: the presence of pure embryonal carcinoma in the primary tumor, liver metastases measuring > 30 111m in greatest dimension at the time of surgery, and the presence of viable, active residual disease. Conclusions. Because it is impossible to determine the histologic pattern o f,, residual liver masses after chemotherapy with current imaging tools and percutaneous biopsy, patient selection for liver surgery may be undertaken according to the size of residual liver masses. Patients with masses that measure less than or equal to 10 nim in greatest dimension should be consid ered for close follow-up, because they have a high probability of necrosis and are at low risk for malignant disease. Male patients with masses that m easure ! 30 mm in greatest dimension represent a high-risk group of patient s who are not likely to benefit from liver surgery. Only male patients with masses that measure 10-29 mm in greatest dimension and all female patients with masses that measure > 10 mm in greatest dimension should be considere d for liver resection. Cancer 2001;92:578-87. (C) 2001 American Cancer Soci ety.