Resection of primary mediastinal non-seminomatous germ cell tumors: A 28-year experience at Memorial Sloan-Kettering Cancer Center Journal Article
| Authors: | Sarkaria, I. S.; Bains, M. S.; Sood, S.; Sima, C. S.; Reuter, V. E.; Flores, R. M.; Motzer, R. J.; Bosl, G. J.; Rusch, V. W. |
| Article Title: | Resection of primary mediastinal non-seminomatous germ cell tumors: A 28-year experience at Memorial Sloan-Kettering Cancer Center |
| Abstract: | Introduction: Surgical resection of residual tumor mass in responders to platinum-based chemotherapy has evolved as the preferred treatment of primary mediastinal nonseminomatous germ cell tumors (PMNGCTs). We reviewed a single institution's operative experience with these rare tumors. Methods: We reviewed charts of patients resected for PMNGCT at Memorial Sloan-Kettering Cancer Center between July 1980 and April 2008. Analyses included Kaplan-Meier survival with univariate log-rank comparisons and Cox multivariate regression. Results: Fifty-seven patients were identified and followed up for a median of 5.3 years. Fifty-four of them received platinum-based preoperative chemotherapy, and 28 (49%) had limited stage I/II disease. Preoperative tumor markers normalized or decreased in 79% of patients. The most common surgical approach was anterolateral thoracotomy with partial sternotomy ("hemiclamshell," 38.6%). An R0 resection was achieved in 91% of the patients with a major morbidity of 17.5% and no postoperative deaths. The median overall survival was 31.5 months. Factors correlating with better survival on univariate analyses were necrosis or teratoma versus residual cancer on final pathology (p = 0.001), R0 resection (p = 0.03), normalized or decreased postchemotherapy/preoperative tumor markers (p < 0.001), normalized postoperative tumor markers (p = 0.004), stage I/II disease (p = 0.03), and surgery after 2000 versus 1980-1999 (p = 0.01). An exploratory multivariate analysis suggests that normalized or decreased postchemotherapy/preoperative tumor markers is the strongest independent predictor of improved survival. Conclusions: In a cohort of PMNGCT patients in which 91% of the patients underwent complete posttherapy resection, response to chemotherapy, measured by normalized or decreased preoperative tumor markers, was the strongest predictor of improved survival. Copyright © 2011 by the International Association for the Study of Lung Cancer. |
| Keywords: | adolescent; adult; cancer survival; controlled study; treatment outcome; bone neoplasms; middle aged; bone tumor; cancer surgery; primary tumor; survival rate; retrospective studies; young adult; major clinical study; histopathology; cisplatin; cancer combination chemotherapy; liver neoplasms; cancer patient; preoperative care; cancer staging; outcome assessment; brain tumor; follow up; brain neoplasms; follow-up studies; neoplasm staging; metastasis; neoplasm recurrence, local; etoposide; bleeding; thoracotomy; antineoplastic combined chemotherapy protocols; lung neoplasms; medical record review; necrosis; tumor marker; prediction; ifosfamide; time factors; postoperative complication; lung tumor; length of stay; hospitalization; disease severity; neoplasm, residual; tumor recurrence; liver tumor; operation duration; carcinoma; bleomycin; surgery; teratoma; neoplasms, germ cell and embryonal; germ cell tumor; sternotomy; mediastinum tumor; mediastinal neoplasms; thorax wall tumor; yolk sac tumor; non seminomatous germinoma; chorionic gonadotropin beta subunit; surgical patient; tumor markers; mediastinal mass; primary mediastinal non seminomatous germ cell tumor |
| Journal Title: | Journal of Thoracic Oncology |
| Volume: | 6 |
| Issue: | 7 |
| ISSN: | 1556-0864 |
| Publisher: | Elsevier Inc. |
| Date Published: | 2011-07-01 |
| Start Page: | 1236 |
| End Page: | 1241 |
| Language: | English |
| DOI: | 10.1097/JTO.0b013e31821d513e |
| PROVIDER: | scopus |
| PUBMED: | 21610519 |
| DOI/URL: | |
| Notes: | --- - "Export Date: 17 August 2011" - "Source: Scopus" |
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