Título

PROLONGED SURVIVAL AFTER THORACIC METASTASECTOMY IN PATIENTS WITH NONSEMINOMATOUS TESTICULAR CANCER.

Objetivo

The paradigm of chemotherapy followed by surgery to treat nonseminomatous germinative cell (NSGCT) testicular with residual metastatic thoracic disease is a successful multimodality cancer treatment model. An estimated 10-20% of patients with advanced stage metastatic NSGCT previously treated with chemotherapy will develop extratesticular tumors and require intrathoracic metastasectomy. The aim of this study is to determine long-term survival rates of patients with testicular germ cell tumors undergoing intrathoracic metastasectomy after chemotherapy.

Método

We identified consecutive patients with NSGCT and intrathoracic metastasis who received comprehensive systemic therapy between January 2011 and June 2022. A retrospective study to analyze treatment outcomes and overall survival using Kaplan-Meier method was conducted.

Resultados

Thirty-seven male patients with testis cancer were included with a median age of 31.8 years (S.D±7.5). Six patients presented with synchronous thoracic metastasis (mediastinum and the lung), nine patients had lung metastasis and 22 patients had mediastinal metastasis. More than half of the patients also had metastasis to retroperitoneal lymph nodes. According to the International Germ Cell Cancer Collaborative Group risk category 48.7% were considered good risk, 16.2% intermediate risk, and 35.1% were poor risk. 22 of 37 residual metastasis had dissimilar pathologies, with a discordant rate of 62%. Teratoma and embryonal carcinoma were the most prevalent primary tumor types, representing 40.5% each, but in the metastasis group, teratoma was by far the predominant cell type (70,3%). Only 8.3% of all intrathoracic metastasis (pulmonary and mediastinal) contained viable GCT, the rest represented either necrosis/fibrosis or mature teratoma (91.7%). Thoracotomy was the most frequent surgical approach (39.2%) followed by VATS (37.2%), cervico-sternotomy (9.8%), sternotomy (5.8%), and clamshell (3.9%). Lung resection was performed in 40.5% of cases. Those who underwent surgery by a planned, sequential or stage thoracotomy were considered to have had a first-time metastasectomy. Overall 10-year survival rates were 94.3% with no surgical-related mortality, despite four patients having nonfatal postoperative complications, including bilateral phrenic nerve injury, bronchopleural fistula, and two superficial wound infections.

Conclusões

Comprehensive multimodality treatment with systemic therapy followed by radical surgery offers a high rate of cure to patients with intrathoracic metastatic testicular germ cell tumors.

Área

Cirurgia do Mediastino