Postchemotherapy resections of residual masses from metastatic nonseminomatous testicular germ cell tumors. A Spanish Germ Cell Group study

Abstract

4525 Background: After chemotherapy for metastatic testicular tumors masses may remain. We analyze factors influencing histology and long-term evolution of patients with post-chemotherapy residual masses. Methods: 352 patients with nonseminomatous germ cell tumors with postchemotherapy residual masses and negative tumor markers were selected from the database of the Spanish Germ Cell Group between December 94 and February 04. Our protocol recommends surgical resection of masses larger than 2 cm. Patients with masses between 1 and 2 cm were offered follow-up or surgical resection. Of them 292 were finally operated: IGCCCG class: 137 (47%), 72 and 83 (28%) for good, intermediate and bad prognosis group respectively. Results: Median follow-up: 4 yrs. Thirty patients need 2 resections, 8 patients 3 and 3 patients 4 surgical maneuvers. Histology of masses: necrosis in 116 (40%), teratoma in 135 (46%), malignant tumor in 41 (14%). IGCCCG and Royal Marsdem class, histology of the primary, age and prechemotherapy size were correlated (X2 test) with histology of the residual masses. Lesions >5 cm before chemo and intermediate or bad prognosis group of the IGCCCG significantly correlated with necrosis. Statistically significant factors predicting teratoma were primary containing teratomatous elements, patient belonging to the good prognosis group and lesions below 5 cm before treatment. We did not identify factors correlated to malignant tumor. Analysis for survival: both IGCCCG class and malignant tumor at surgery were statistically significant in the multivariate analysis (p<0.001), whereas size, Royal Marsdem Class or histology of the primary were not. Five-year survival was 75%, 93% and 95% if malignant tumor, teratoma or necrosis were found respectively. Good, intermediate and bad prognosis group had a 5-yr survival of 97, 87 and 81% respectively. Conclusions: Our results suggest that persistence of small lesions after chemotherapy together with teratomatous elements in the primary predicts teratoma at surgery. IGCCCG class and persistence of malignant cells at surgery are the strongest prognostic factors for survival after resection of residual masses. No significant financial relationships to disclose.