Post-chemotherapy surgery in advanced non-seminomatous germ-cell testicular tumours: the significance of histology with particular reference to differentiated (mature) teratoma

Abstract

Summary Of a total of 307 patients treated with chemotherapy for advanced non-seminomatous germ-cell testicular tumours between 1976 and 1983, 73 (23.8%) had masses excised after treatment. Resected tissue showed residual malignancy in 16 (22%), fibrosis and necrosis in 25 (34%) and differentiated (mature teratoma) in 32 (44%). Of the 16 patients with tumour only 7 (44%) are alive and disease-free compared with 21/25 (84%) and 27/32 (84%) for fibrosis/necrosis and differentiated teratoma respectively. In addition to histological evidence of residual tumour, elevated serum markers at the time of surgery and/or incomplete excision of residual masses were adverse prognostic features. Of 12 patients with differentiated teratoma or fibrosis who had incomplete resections or densely adherent masses excised with difficulty, 7 subsequently relapsed.The majority of differentiated teratoma patients (75%) had evidence of differentiation in their primary tumours; 88% showed cystic change in metastases and almost one-third showed an increase in the size of metastases during chemotherapy.The data suggest that post-chemotherapy surgery may have a therapeutic as well as a diagnostic role and that complete excision of residual disease should be attempted even if resection at one site has shown either fibrosis or differentiated teratoma. The significance of these findings in relation to treatment induced differentiation is discussed.

Prognosis after resection of residual masses following chemotherapy for metastatic nonseminomatous testicular cancer: a multivariate analysis

“…However, the fraction of resected patients varies widely between these studies, e.g. from around 20% (Tait et al, 1984;Mead et al, 1992) to over 85% (Mulders et al, 1990;Aass et al, 1991). The wide variation in the fraction of patients in whom it was deemed necessary to undergo resection may partly be explained by the heterogeneity of the patient groups, but also reflects the lack of agreement on the selection criteria for surgery after chemotherapy.…”

Prediction of relapse after lymph node dissection for germ cell tumours: can salvage chemotherapy be avoided?

“…Immunohistochemical studies have been performed in patients with clinical stage I disease and correlated with later metastasis, but have not been investigated in the residual masses (Eid et al, 1998). Richie and Kantoff (1991) had only 3/39 (8%) relapses in their series, while Tait et al (1984) had a relapse rate of 9/16 (56%). In the largest series (Stenning et al, 1998), 25% of all their patients (including those with teratoma, differentiated or necrosis) experienced disease progression and 60% of those with malignant elements relapsed.…”

The significance of resections for residual masses after chemotherapy in metastatic testicular tumors

“…The size of retroperitoneal and lung metastases was significantly correlated with the completeness of resection and the prognosis of patients with incomplete resection has been reported as poor. 16,24,25 In conclusion, resection for residual masses after chemotherapy in metastatic testicular tumors is useful in confirming the tissue of the residual mass and in controlling the metastatic sites because all recurrences after surgery were found in different sites from those of previous resection. Patients with cancer in residual masses were often found in stage III and the incidence of cancer appearance was not related to the size of residual masses or the histology of primary testicular tumors.…”