Findings in lymph nodes of patients with germ cell tumours after chemotherapy and their relation to prognosis.

Abstract

One hundred and forty six patients with advanced germ cell testicular tumours (38 seminomas and 108 malignant teratomas) treated by combination chemotherapy were studied over 10 years. Most of the improvement seen was in patients with malignant teratoma undifferentiated. In the most recently treated patients (1984-1987) 75% of drug resistant cases were malignant teratoma intermediate compared with 26% in the series treated between 1978-1983. The microscopic features of 52 primary testicular tumours were compared with features seen in excised retroperitoneal lymph nodes after completion of chemotherapy. Primary malignant teratoma intermediate had a higher incidence of viable malignancy in the excised tissue than malignant teratoma undifferentiated. Mature teratoma or fibronecrotic tissue within resected tissue was associated with a good prognosis. If resection was complete patients with drug resistant malignant teratoma intermediate had a more favourable prognosis than drug resistant malignant teratoma undifferentiated. It is advised that retroperitoneal node dissection should be considered in the management of patients with advanced germ cell testicular tumours, and that as complete a resection as possible be attempted to avoid the danger of missing residual disease.

Intensive Chemotherapy in Poor-Prognosis Nonseminomatous Germ Cell Tumors of the Testis

“…In the BOMP/EPI group, no patient had viable carcinoma compared to 5 patients (24%) in the PVB group. Two relapses occurred in these 5 patients; this figure, similar to the experience of other authors [17,18], emphasises the importance of achieving a cCR or pCR because of the high rate of relapses in patients with residual cancer which provides foci for dis ease relapse [19]. The median follow-up in the intensive chemotherapy group (41 months) is longer than in most of the reported studies.…”