Author of

• 20181

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  P2.17 - Thymic Malignancies/Esophageal Cancer/Other Thoracic Malignancies (ID 718)

  • Event: WCLC 2017
  • Type: Poster Session with Presenters Present
  • Track: Thymic Malignancies/Esophageal Cancer/Other Thoracic Malignancies
  • Presentations: 1
  • Moderators:
  • Coordinates: 10/17/2017, 09:30 - 16:00, Exhibit Hall (Hall B + C)

  • 23563

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    P2.17-004 - Salvage Surgery for Pulmonary Metastases in Patients with Testicular Germ Cell Tumors (ID 10054)

    09:30 - 09:30  |  Author(s): S. Ueda
    • Abstract

    Background:
    Germ cell tumors of testicular origin are the most common malignancy in young males. The lungs and the retroperitoneal space are frequently the initial sites of metastatic disease. Salvage surgery is an important treatment modality for residual post-chemotherapy pulmonary masses. We analyzed the prognostic predictors of survival in the patients after pulmonary metastasectomy.
    
    Method:
    Between September 1989 and December 2015, 32 patients underwent pulmonary resection of thoracic metastases following cisplatin-based chemotherapy. Germ cell tumors of mediastinal origin were excluded. These patients’ records were subsequently reviewed.
    
    Result:
    All patients underwent high orchidectomy and cisplatin-based chemotherapy.　　The primary tumor histology demonstarated 2 seminomas and 30 nonseminomatous germ cell tumors. Twenty-three patients (72%) received two or more chemotherapy regimens. International Germ Cell Cancer Collaborative Group classification, TNM factors, and serum tumor marker level at diagnosis were not associated with prognosis after pulmonary metastasectomy. The mean age at pulmonary surgery was 31.9 years. The surgical procedures included wedge resection in 23 (72%) and segmentectomy/lobectomy in 9 (28%). There were no perioperative deaths and major postoperative complications. The overall 5-year survival rate was 73% after an average follow-up of 55 months. The pathology of residual pulmonary masses revealed viable tumor cells in 12 patients (38%), necrosis alone in 18 patients (56%), and mature teratoma alone in 2 patients (6%). Preoperative increased lactic dehydrogenase (LDH) levels were significantly associated with the viable tumor cells of residual masses. The size of pulmonary metastases has not been found to be statistically related to malignant tumor cells. A significantly poor survival was observed using univariate analysis in patients with preoperative high free-βHCG (p=0.012), high intact HCG (p=0.031), high LDH (p<0.001), removing 5 or more lung metastases(p=0.012), and viable tumor cells of residual masses (p=0.026).
    
    Conclusion:
    We conclude that pulmonary resection in metastatic testicular tumors is a safe and effective treatment strategy. Increased tumor marker levels, free-βHCG/intact HCG or LDH, removing 5 or more lung metastases, and viable tumor cells of residual masses were identified as prognosis-related criteria for a poor prognosis.