Analysis of Risk Factors Following Resection of Lung Metastases of Patients with Malignant Germ Cell Tumors

G Stoleriu; E Stacher-Priehse; GT Stathopoulos; M Lindner; RA Hatz; G Preissler

doi:10.1055/s-0039-1694146

Zentralblatt für Chirurgie - Zeitschrift für Allgemeine, Viszeral-, Thorax- und Gefäßchirurgie, Table of Contents

Zentralbl Chir 2019; 144(S 01): S74
DOI: 10.1055/s-0039-1694146

Vorträge – DACH-Jahrestagung: nummerisch aufsteigend sortiert

Georg Thieme Verlag KG Stuttgart · New York

Analysis of Risk Factors Following Resection of Lung Metastases of Patients with Malignant Germ Cell Tumors

G Stoleriu

¹Center for Thoracic Surgery Munich, Ludwig-Maximilians-University of Munich (LMU) and Asklepios Medical Center, Member of the German Center for Lung Research (DZL), Gauting, Bavaria, Germany

²Comprehensive Pneumology Center and Institute for Lung Biology and Disease, University Hospital, Ludwig-Maximilians University of Munich (LMU) and Helmholtz Center Munich, Member of the German Center for Lung Research (DZL), Munich, Bavaria, Germany.

,

E Stacher-Priehse

³Department of Pathology, Asklepios Medical Center, Gauting, Bavaria, Germany

,

GT Stathopoulos

²Comprehensive Pneumology Center and Institute for Lung Biology and Disease, University Hospital, Ludwig-Maximilians University of Munich (LMU) and Helmholtz Center Munich, Member of the German Center for Lung Research (DZL), Munich, Bavaria, Germany.

,

M Lindner

¹Center for Thoracic Surgery Munich, Ludwig-Maximilians-University of Munich (LMU) and Asklepios Medical Center, Member of the German Center for Lung Research (DZL), Gauting, Bavaria, Germany

²Comprehensive Pneumology Center and Institute for Lung Biology and Disease, University Hospital, Ludwig-Maximilians University of Munich (LMU) and Helmholtz Center Munich, Member of the German Center for Lung Research (DZL), Munich, Bavaria, Germany.

,

RA Hatz

¹Center for Thoracic Surgery Munich, Ludwig-Maximilians-University of Munich (LMU) and Asklepios Medical Center, Member of the German Center for Lung Research (DZL), Gauting, Bavaria, Germany

,

G Preissler

⁴Department of Thoracic surgery, Pulmonary Hospital Schillerhöhe, Gerlingen, Stuttgart, Germany

› Author Affiliations

Abstract

Full Text

Background:

Germ cell tumors are rare malignancies that spread rapidly to the lung, thereby negatively influencing overall survival (OS). Complete resection of the primary tumor, combined with chemotherapy (CTX) and pulmonary metastasectomy represent the therapy of choice. However, prognostic factors remain poorly characterized. Therefore, in this two center study, the clinical course of patients undergoing resection of pulmonary metastases (MTS) in germ cell tumors was analyzed.

Material and method:

Here, 34 patients (2♀/32♂, median age 33 years) undergoing resection of MTS from 1994 to 2017 were analyzed, retrospectively. We studied the impact of CTX, R0, N0-status, time of onset and MTS-histology on OS. OS analysis used the Kaplan Meier method. Results are given as mean/median ± SD.

Results:

CTX prior to metastasectomy (87,5%) was associated with increased 10 years survival probability by trend (80% vs. 50%, p = 0,148). Pre-OP ASA score I was associated with improved OS (ASA I vs. ASA II/III 303 ± 24 vs. 146 ± 31 months, p = 0,036). Metachronous MTS (16,1%) were resected 31 ± 16 months after primary tumor diagnosis and were associated with an OS of 5 ± 5 months. Synchronous MTS (83,9%) were associated with a significantly better OS (279 ± 27, p < 0,001). R0-Resection was performed in 85,3% of cases, whereas N0-status after radical/partial lymphadenectomy was observed in 66,7% and 90% of the patients. Lymph node involvement was associated with significantly worse OS (N0 vs. N+ 316 ± 22 vs. 8 ± 3 months, p < 0,0001). Histology of the MTS revealed vital tumor cells in 67,6% and necrosis in 32,4% of cases. OS in those groups was 203 ± 36 vs. 244 ± 27 months (p = 0,148). Compared to seminoma (5,9%) and embryonal carcinoma (11,8%), chorioncarcinoma (11,8%) and yolk sac tumors (5,9%) were associated with increased 10 years survival probability (100% vs. 18%, p = 0,009).

Conclusion:

Favorable prognostic factors in patients with MTS of germ cell tumors include ASA score ≤1, chorioncarcinoma and yolk sac tumor as primary diagnosis. Hilar/mediastinal lymph node involvement and metachronous MTS represent negative prognostic factors, therefore lymph node dissection should be performed routinely. In this young group of patients risk factor associated stratification could guide further adjuvant therapeutical strategies.