Resection of primary mediastinal non-seminomatous germ cell tumors: A 28-year experience at memorial sloan-kettering cancer center

Inderpal S. Sarkaria, Manjit S. Bains, Shelly Sood, Camelia S. Sima, Victor E. Reuter, Raja M. Flores, Robert J. Motzer, George J. Bosl, Valerie W. Rusch

Research output: Contribution to journalArticlepeer-review

35 Scopus citations

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.

Original languageEnglish
Pages (from-to)1236-1241
Number of pages6
JournalJournal of Thoracic Oncology
Volume6
Issue number7
DOIs
StatePublished - Jul 2011

Keywords

  • Germ Cell Tumor
  • Mediastinal Mass
  • Surgery
  • Tumor Markers

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