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Surgical Management of Patients with Advanced Germ Cell Tumors Following Salvage Chemotherapy: Memorial Sloan Kettering Cancer Center (MSKCC) Experience.

  • Author Footnotes
    1 Since completion of this work, Dr. Miller's affiliation has changed to Alaska Native Medical Center.
    Mariam Imnadze Miller
    Correspondence
    Address correspondence to: Mariam Imnadze Miller, M.D., Alaska Native Medical Center, 4315 Diplomacy Drive, Anchorage, AK 99508.
    Footnotes
    1 Since completion of this work, Dr. Miller's affiliation has changed to Alaska Native Medical Center.
    Affiliations
    Urology Service, Department of Surgery, Sidney Kimmel Center for Prostate and Urological Cancers, Memorial Sloan Kettering Cancer Center, New York, NY
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  • Author Footnotes
    2 Since completion of this work, Dr. Feifer's affiliation has changed to University of Toronto.
    Andrew Feifer
    Footnotes
    2 Since completion of this work, Dr. Feifer's affiliation has changed to University of Toronto.
    Affiliations
    Urology Service, Department of Surgery, Sidney Kimmel Center for Prostate and Urological Cancers, Memorial Sloan Kettering Cancer Center, New York, NY
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  • Darren R. Feldman
    Affiliations
    Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY
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  • Brett S. Carver
    Affiliations
    Urology Service, Department of Surgery, Sidney Kimmel Center for Prostate and Urological Cancers, Memorial Sloan Kettering Cancer Center, New York, NY
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  • George J. Bosl
    Affiliations
    Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY
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  • Robert J. Motzer
    Affiliations
    Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY
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  • Dean F. Bajorin
    Affiliations
    Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY
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  • Joel Sheinfeld
    Affiliations
    Urology Service, Department of Surgery, Sidney Kimmel Center for Prostate and Urological Cancers, Memorial Sloan Kettering Cancer Center, New York, NY
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  • Author Footnotes
    1 Since completion of this work, Dr. Miller's affiliation has changed to Alaska Native Medical Center.
    2 Since completion of this work, Dr. Feifer's affiliation has changed to University of Toronto.
Published:October 05, 2018DOI:https://doi.org/10.1016/j.urology.2018.09.024

      Abstract

      Objective

      To characterize clinical and pathologic outcomes of cisplatin-refractory or relapsed germ cell tumor (GCT) patients who underwent retroperitoneal lymph node dissection (RPLND) following salvage chemotherapy with either conventional or high dose regimens.

      Methods

      Data were reviewed to identify all patients treated with TIP or TICE salvage chemotherapy between 1994 and 2011(n = 184) at our institution. We report clinicopathologic and outcomes data on 131 patients who were further managed with surgical resection. Using Cox-proportional hazards models, predictors of disease-specific survival (DSS) were analyzed.

      Results

      Median follow-up was 7.3 years. Of the 112 patients who underwent postsalvage chemotherapy RPLND, histology was reported as viable GCT in 30 (27%), teratoma only in 26 (23%) and fibrosis in 56 (50%). 5-year DSS for the entire cohort was 74% (95% confidence interval 63%-80%). On multivariable analysis, viable GCT histology at RPLND or extra-RPLND resection predicted for worse DSS (hazard ratio 7.37, P = .003).

      Conclusions

      Our data suggest that approximately half of the patient with cisplatin-refractory or relapsed GCT salvaged with TIP or TICE chemotherapy and evidence of residual disease are at risk of harboring either viable GCT or teratoma. This finding underlines the critical role of surgery in the multimodality approach to the management of this advanced disease entity. If retroperitoneal disease exists prior to salvage chemotherapy, we recommend postchemotherapy resection in all eligible patients.
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