POSTCHEMOTHERAPY RESECTIONS OF RESIDUAL MASSES FROM METASTATIC NONSEMINOMATOUS TESTICULAR GERM-CELL TUMORS

Purpose. To analyse the frequencies of histological findings: predicti ve: factors for the presence of undifferentiated tumor and variables i nfluencing the survival of patients with nonseminomatous germ cell tum ors who underwent secondary resection of residual masses after cisplat in-based combination chemotherapy. Patients and methods. 134 patients with a median age of 26 years (15-47) undergoing at least one surgical intervention at Hannover University Medical School were included. One hundred nine patients had received first-line chemotherapy and 25 und erwent surgery after second-line chemotherapy. Results. After first-li ne chemotherapy the distribution of histologic:al findings was 52% nec rosis, 27% differentiated teratoma and 21% undifferentiated tumor for 82 patients with marker negative PR (PRm-). Incompletely resected mass and failure to achieved complete tumor marker normalisation were sign ificantly associated with the finding of undifferentiated tumor. Five- year progression-free survival rates according to histological finding s were 78%, 67% and 66% for necrosis, differentiated teratoma and undi fferentiated tumor. Patients with undifferentiated tumor in the resect ed specimen routinely received postoperative additional chemotherapy. Factors asso-ciated with a worse overall survival were progressive dis ease within three months, persistent AFP elevation prior to surgery pr echemotherapy elevated LDH levels or mediastinal lymph node involvemen t at primary diagnosis. In 8 of 27 patients (30%) undergoing multiple resections at different sites a dissimilar histology was found. In the 25 patients operated after salvage chemotherapy undifferentiated tumo r was found in 80%. A five-year survival of 44% compared to 80% after first-line chemotherapy was achieved. Conclusions. Resection of residu al rumors after first-line chemotherapy remains essential in the treat ment of metastatic testicular cancer. Undifferentiated tumor may still be found in 20% of patients despite achieving PRm- after first-line c hemotherapy. Necrosis is found in only 50% of marker normalized patien ts after first-line and approximately 30% after second-line chemothera py. Future Studies have to prove whether the combination of clinical p rognostic factors and the use of PET-scanning will allow to spare subs ets of patients from secondary resection.