Advertisement

Annals of Surgical Oncology

, Volume 25, Issue 12, pp 3668–3675 | Cite as

Nodule Size After Chemotherapy and Primary-Tumor Teratoma Components Predict Malignancy of Residual Pulmonary Nodules in Metastatic Nonseminomatous Germ Cell Tumor

  • Yuta Toyoshima
  • Tomohiko Hara
  • Yoshiyuki Matsui
  • Yoshiyuki Nagumo
  • Aiko Maejima
  • Yasuo Shinoda
  • Motokiyo Komiyama
  • Shun-ichi Watanabe
  • Hiroyuki Fujimoto
Thoracic Oncology
  • 67 Downloads

Abstract

Background

The treatment goal for visceral metastatic nonseminomatous germ cell tumor (NSGCT) is to remove any residual teratoma or viable NSGCT after chemotherapy. However, this provides no therapeutic benefit to patients whose metastases necrotize on their own. This study therefore analyzed NSGCTs with pulmonary metastases to determine preoperative factors that predict necrosis and could help identify patients who might be treated with monitoring rather than surgery.

Methods

The study retrospectively analyzed 41 patients (135 metastatic pulmonary nodules) treated from 1997 to 2016 for NSGCT who showed tumor marker normalization after chemotherapy. Relationships between clinicopathologic characteristics and necrosis in resected pulmonary specimens were analyzed.

Results

Receiver operating characteristic analysis of the pulmonary nodules showed 9 mm to be the optimal cutoff length for predicting necrosis. The logistic regression model showed that absence of teratoma components in the primary tumor and all pulmonary nodules shorter than 10 mm after chemotherapy both were independent predictors of pathologic necrosis in pulmonary specimens. No patients experienced late recurrence (i.e., > 2 years afterward).

Conclusions

The presence of teratoma components in primary tumors and nodular size after chemotherapy predict the pathology of residual pulmonary nodules. Patients whose residual nodules all are shorter than 10 mm and who have no primary-tumor teratoma components might be candidates for careful monitoring before pulmonary resection.

Notes

Acknowledgment

We are grateful for the cooperation of the staff at the National Cancer Center Hospital, Tokyo, Japan. We thank Marla Brunker, MSc, from the Edanz Group (www.edanzediting.com/ac) for editing a draft of this manuscript.

Disclosure

There are no conflicts of interest.

Supplementary material

10434_2018_6742_MOESM1_ESM.pptx (62 kb)
Supplementary material 1 (PPTX 62 kb)

References

  1. 1.
    Albers P, Albrecht W, Algaba F, et al. Guidelines on testicular cancer: 2015 update. Eur Urol. 2015;68:1054–68.CrossRefGoogle Scholar
  2. 2.
    Williamson SR, Delahunt B, Magi-Galluzzi C, et al. The World Health Organization 2016 classification of testicular germ cell tumours: a review and update from the International Society of Urological Pathology Testis Consultation Panel. Histopathology. 2017;70:335–46.CrossRefGoogle Scholar
  3. 3.
    Krege S, Beyer J, Souchon R, et al. European consensus conference on diagnosis and treatment of germ cell cancer: a report of the second meeting of the European Germ Cell Cancer Consensus Group (EGCCCG): part II. Eur Urol. 2008;53:497–513.CrossRefGoogle Scholar
  4. 4.
    Cagini L, Nicholson AG, Horwich A, Goldstraw P, Pastorino U. Thoracic metastasectomy for germ cell tumours: long-term survival and prognostic factors. Ann Oncol. 1998;9:1185–91.CrossRefGoogle Scholar
  5. 5.
    Liu D, Abolhoda A, Burt ME, et al. Pulmonary metastasectomy for testicular germ cell tumors: a 28-year experience. Ann Thorac Surg. 1998;66:1709–14.CrossRefGoogle Scholar
  6. 6.
    Schirren J, Trainer S, Eberlein M, Lorch A, Beyer J, Bolukbas S. The role of residual tumor resection in the management of nonseminomatous germ cell cancer of testicular origin. Thorac Cardiovasc Surg. 2012;60:405–12.CrossRefGoogle Scholar
  7. 7.
    Ravi P, Gray KP, O’Donnell EK, Sweeney CJ. A meta-analysis of patient outcomes with subcentimeter disease after chemotherapy for metastatic non-seminomatous germ cell tumor. Ann Oncol. 2014;25:331–8.CrossRefGoogle Scholar
  8. 8.
    Heidenreich A, Pfister D. Retroperitoneal lymphadenectomy and resection for testicular cancer: an update on best practice. Ther Adv Urol. 2012;4:187–205.CrossRefGoogle Scholar
  9. 9.
    Rivoire M, Elias D, De Cian F, Kaemmerlen P, Theodore C, Droz JP. Multimodality treatment of patients with liver metastases from germ cell tumors: the role of surgery. Cancer. 2001;92:578–87.CrossRefGoogle Scholar
  10. 10.
    Steyerberg EW, Keizer HJ, Messemer JE, et al. Residual pulmonary masses after chemotherapy for metastatic nonseminomatous germ cell tumor: prediction of histology. Cancer. 1997;79:345–55.CrossRefGoogle Scholar
  11. 11.
    Steyerberg EW, Keizer HJ, Fossa SD, et al. Resection of residual retroperitoneal masses in testicular cancer: evaluation and improvement of selection criteria: re-analysis of histology in testicular cancer. The ReHiT study group. Br J Cancer. 1996;74:1492–8.CrossRefGoogle Scholar
  12. 12.
    Nakamura T, Miki T. Recent strategy for the management of advanced testicular cancer. Int J Urol. 2010;17:148–57.CrossRefGoogle Scholar
  13. 13.
    Brunelli A, Salati M, Rocco G, et al. European risk models for morbidity (EuroLung1) and mortality (EuroLung2) to predict outcome following anatomic lung resections: an analysis from the European Society of Thoracic Surgeons database. Eur J Cardiothorac Surg. 2017;51:490–7.CrossRefGoogle Scholar
  14. 14.
    Endo S, Ikeda N, Kondo T, et al. Model of lung cancer surgery risk derived from a Japanese nationwide web-based database of 78,594 patients during 2014–2015. Eur J Cardiothorac Surg. 2017;52:1182–9.CrossRefGoogle Scholar
  15. 15.
    Mead GM, Stenning SP, Cook P, et al. International germ cell consensus classification: a prognostic factor-erased staging system for metastatic germ cell cancers. J Clin Oncol. 1997;15:594–603.CrossRefGoogle Scholar
  16. 16.
    Kanda Y. Investigation of the freely available easy-to-use software “EZR” for medical statistics. Bone Marrow Transplant. 2013;48:452–8.CrossRefGoogle Scholar
  17. 17.
    Besse B, Grunenwald D, Fléchon A, et al. Nonseminomatous germ cell tumors: assessing the need for postchemotherapy contralateral pulmonary resection in patients with ipsilateral complete necrosis. J Thorac Cardiovasc Surg. 2009;137:448–52.CrossRefGoogle Scholar
  18. 18.
    Steyerberg EW, Donohue JP, Gerl A, et al. Residual masses after chemotherapy for metastatic testicular cancer: the clinical implications of the association between retroperitoneal and pulmonary histology. J Urol. 1997;158:474–8.CrossRefGoogle Scholar
  19. 19.
    McGuire MS, Rabbani F, Mohseni H, Bains M, Motzer R, Sheinfeld J. The role of thoracotomy in managing postchemotherapy residual thoracic masses in patients with nonseminomatous germ cell tumours. BJU Int. 2003;91:469–73.CrossRefGoogle Scholar
  20. 20.
    Schmoll HJ, Osanto S, Kawai K, Einhorn L, Fizazi K. Advanced seminoma and nonseminoma: SIU/ICUD consensus meeting on germ cell tumors (GCT), Shanghai 2009. Urology. 2011;78:S456–68.CrossRefGoogle Scholar
  21. 21.
    Nakamura T, Oishi M, Ueda T, et al. Clinical outcomes and histological findings of patients with advanced metastatic germ cell tumors undergoing post-chemotherapy resection of retroperitoneal lymph nodes and residual extraretroperitoneal masses. Int J Urol. 2015;22:663–8.CrossRefGoogle Scholar
  22. 22.
    Toner GC, Panicek DM, Heelan RT, et al. Adjunctive surgery after chemotherapy for nonseminomatous germ cell tumors: recommendations for patient selection. J Clin Oncol. 1990;8:1683–94.CrossRefGoogle Scholar
  23. 23.
    Kang MC, Kang CH, Lee HJ, Goo JM, Kim YT, Kim JH. Accuracy of 16-channel multi-detector row chest computed tomography with thin sections in the detection of metastatic pulmonary nodules. Eur J Cardiothorac Surg. 2008;33:473–9.CrossRefGoogle Scholar
  24. 24.
    Culine S, Kerbrat P, Kramar A, et al. Refining the optimal chemotherapy regimen for good-risk metastatic nonseminomatous germ-cell tumors: a randomized trial of the Genito-Urinary Group of the French Federation of Cancer Centers (GETUG T93BP). Ann Oncol. 2007;18:917–24.CrossRefGoogle Scholar

Copyright information

© Society of Surgical Oncology 2018

Authors and Affiliations

  • Yuta Toyoshima
    • 1
  • Tomohiko Hara
    • 1
  • Yoshiyuki Matsui
    • 1
  • Yoshiyuki Nagumo
    • 1
  • Aiko Maejima
    • 1
  • Yasuo Shinoda
    • 1
  • Motokiyo Komiyama
    • 1
  • Shun-ichi Watanabe
    • 2
  • Hiroyuki Fujimoto
    • 1
  1. 1.Urology DivisionNational Cancer Center HospitalTokyoJapan
  2. 2.Thoracic Surgery DivisionNational Cancer Center HospitalTokyoJapan

Personalised recommendations