Adjunctive surgery after chemotherapy for nonseminomatous germ cell tumors: recommendations for patient selection.

摘要: One hundred eighty-five patients who underwent surgery within 6 months of completing chemotherapy were identified from 360 with nonseminomatous germ cell tumors (NSGCT) treated Memorial Hospital front-line cisplatin- or carboplatin-based combination protocols between 1979 and 1988. Clinical, pathologic, radiologic features correlated the pathologic findings at surgery. The size a residual retroperitoneal mass, degree shrinkage that occurred chemotherapy, presence teratomatous elements in pretreatment pathology specimens each resections after chemotherapy. Multivariable logistic regression analysis those undergoing mass prechemotherapy lactate dehydrogenase (LDH) alphafetoprotein (AFP) levels as best predictors finding only necrotic debris. No factors could be found, however, selectively exclude had viable malignancy teratoma retroperitoneum. Of 39 masses measuring less than equal to 1.5 cm maximal diameter, three five resected. for lung mediastinal used select group safely avoid If serum markers have normalized NSGCT, resection all abnormalities on imaging studies retroperitoneum, lungs, mediastinum is recommended. In addition, lymph node dissection (RPLND) recommended initial bulky metastases (greater 3 diameter) irrespective postchemotherapy computed tomography (CT).