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Surgical treatment of malignant mediastinal nonseminomatous germ cell tumor.
Ann Thorac Surg. 2008 Feb; 85(2):379-84.AT

Abstract

BACKGROUND

The aim of this study was to evaluate the role of surgical treatment for mediastinal nonseminomatous germ cell tumors (MNSGCT) and identify the factors of long-term survival.

METHODS

A retrospective review of the medical records of patients with primary MNSGCT who registered at our institute between 1988 and 2005 was performed. Of 29 patients who presented with primary MNSGCT, 21 patients (72.4%) underwent curative resection and were included in this study.

RESULTS

All patients were male and symptomatic at presentation. Mean patient age was 24.4 years (range, 9 to 53 years). Three different regimens were used for preoperative chemotherapy, and 14 patients (66.7%) achieved partial response, 4 (19.0%) had stable disease, and 2 (9.5%) had progressive disease. Complete en bloc excision was possible in 16 patients (76.2%). The most common cause of incomplete resection was great vessel invasion (n = 3). Concomitantly resected organs were lung in 13 patients (61.9%) and superior vena cava in 5 (23.8%). Viable germ cell tumor was identified in pathology specimens in 12 (57.1%), total necrosis in 7 (33.3%), and remnant teratoma in 2 (9.5%). Five-year overall and disease-free survivals were 63.6% and 61.1%. Risk factors for poor overall survival by multivariate analysis were beta-human chorionic gonadotrophin (beta-HCG) elevation at initial diagnosis (p = 0.02) and incomplete resection (p = 0.002).

CONCLUSIONS

Surgical resection of MNSGCT after chemotherapy showed favorable long-term survival. Complete resection should be performed to achieve long-term survival. An elevated beta-HCG level at initial diagnosis was associated with a poor prognosis despite multimodality therapy.

Authors+Show Affiliations

Department of Thoracic and Cardiovascular Surgery, Cancer Research Institute, Seoul National University Hospital, Seoul, South Korea. chkang@snu.ac.krNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article
Research Support, Non-U.S. Gov't

Language

eng

PubMed ID

18222229

Citation

Kang, Chang Hyun, et al. "Surgical Treatment of Malignant Mediastinal Nonseminomatous Germ Cell Tumor." The Annals of Thoracic Surgery, vol. 85, no. 2, 2008, pp. 379-84.
Kang CH, Kim YT, Jheon SH, et al. Surgical treatment of malignant mediastinal nonseminomatous germ cell tumor. Ann Thorac Surg. 2008;85(2):379-84.
Kang, C. H., Kim, Y. T., Jheon, S. H., Sung, S. W., & Kim, J. H. (2008). Surgical treatment of malignant mediastinal nonseminomatous germ cell tumor. The Annals of Thoracic Surgery, 85(2), 379-84. https://doi.org/10.1016/j.athoracsur.2007.09.011
Kang CH, et al. Surgical Treatment of Malignant Mediastinal Nonseminomatous Germ Cell Tumor. Ann Thorac Surg. 2008;85(2):379-84. PubMed PMID: 18222229.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Surgical treatment of malignant mediastinal nonseminomatous germ cell tumor. AU - Kang,Chang Hyun, AU - Kim,Young Tae, AU - Jheon,Sang-Hoon, AU - Sung,Sook-whan, AU - Kim,Joo Hyun, PY - 2007/06/13/received PY - 2007/09/07/revised PY - 2007/09/10/accepted PY - 2008/1/29/pubmed PY - 2008/3/12/medline PY - 2008/1/29/entrez SP - 379 EP - 84 JF - The Annals of thoracic surgery JO - Ann. Thorac. Surg. VL - 85 IS - 2 N2 - BACKGROUND: The aim of this study was to evaluate the role of surgical treatment for mediastinal nonseminomatous germ cell tumors (MNSGCT) and identify the factors of long-term survival. METHODS: A retrospective review of the medical records of patients with primary MNSGCT who registered at our institute between 1988 and 2005 was performed. Of 29 patients who presented with primary MNSGCT, 21 patients (72.4%) underwent curative resection and were included in this study. RESULTS: All patients were male and symptomatic at presentation. Mean patient age was 24.4 years (range, 9 to 53 years). Three different regimens were used for preoperative chemotherapy, and 14 patients (66.7%) achieved partial response, 4 (19.0%) had stable disease, and 2 (9.5%) had progressive disease. Complete en bloc excision was possible in 16 patients (76.2%). The most common cause of incomplete resection was great vessel invasion (n = 3). Concomitantly resected organs were lung in 13 patients (61.9%) and superior vena cava in 5 (23.8%). Viable germ cell tumor was identified in pathology specimens in 12 (57.1%), total necrosis in 7 (33.3%), and remnant teratoma in 2 (9.5%). Five-year overall and disease-free survivals were 63.6% and 61.1%. Risk factors for poor overall survival by multivariate analysis were beta-human chorionic gonadotrophin (beta-HCG) elevation at initial diagnosis (p = 0.02) and incomplete resection (p = 0.002). CONCLUSIONS: Surgical resection of MNSGCT after chemotherapy showed favorable long-term survival. Complete resection should be performed to achieve long-term survival. An elevated beta-HCG level at initial diagnosis was associated with a poor prognosis despite multimodality therapy. SN - 1552-6259 UR - https://www.unboundmedicine.com/medline/citation/18222229/Surgical_treatment_of_malignant_mediastinal_nonseminomatous_germ_cell_tumor_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S0003-4975(07)01866-8 DB - PRIME DP - Unbound Medicine ER -