Multimodality treatment of patients with liver metastases from germ cell tumors: The role of surgery

Michel Rivoire, Dominique Elias, Franco De Cian, Pierre Kaemmerlen, Christine Théodore, Jean Pierre Droz

Research output: Contribution to journalArticle

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Abstract

BACKGROUND. The presence of liver metastases represents an independent poor risk prognostic factor for survival in patients with germ cell tumors. METHODS. The clinical files of 37 patients who had undergone liver resection for the treatment of disseminated germ cell tumors were reviewed to define the indications for resection of residual liver metastases after chemotherapy in patients with germ cell tumors. The histologic patterns of primary tumor and residual disease were compared. The prognostic factors for survival were studied by univariate analysis. RESULTS. All but 2 of 37 patients underwent complete resection. One patient died of postoperative complications. Thirteen complications occurred in 10 patients. Twelve patients had active residual tumor, 7 patients had mature teratoma, and 18 patients had only necrosis on histologic examination. Twenty-three of 37 patients (62%) were alive with no evidence of disease after a median follow-up of 66 months (range, 31-134 months). Three prognostic factors were found to be significant in the univariate analysis for unfavorable outcome: The presence of pure embryonal carcinoma in the primary tumor, liver metastases measuring > 30 mm in greatest dimension at the time of surgery, and the presence of viable, active residual disease. C0NCLUSIONS. Because it is impossible to determine the histologic pattern of residual liver masses after chemotherapy with current imaging tools and percutaneous biopsy, patient selection for liver surgery may be undertaken according to the size of residual liver masses. Patients with masses that measure ≤ 10 mm in greatest dimension should be considered for close follow-up, because they have a high probability of necrosis and are at low risk for malignant disease. Male patients with masses that measure ≥ 30 mm in greatest dimension represent a high-risk group of patients who are not likely to benefit from liver surgery. Only male patients with masses that measure 10-29 mm in greatest dimension and all female patients with masses that measure > 10 mm in greatest dimension should be considered for liver resection.

Original languageEnglish
Pages (from-to)578-587
Number of pages10
JournalCancer
Volume92
Issue number3
DOIs
Publication statusPublished - Aug 1 2001

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Germ Cell and Embryonal Neoplasms
Neoplasm Metastasis
Liver
Therapeutics
Residual Neoplasm
Necrosis
Embryonal Carcinoma
Drug Therapy
Survival
Teratoma
Patient Selection

Keywords

  • Chemotherapy
  • Germ cell tumors
  • Liver metastases
  • Liver surgery
  • Postchemotherapy surgery

ASJC Scopus subject areas

  • Cancer Research
  • Oncology

Cite this

Multimodality treatment of patients with liver metastases from germ cell tumors : The role of surgery. / Rivoire, Michel; Elias, Dominique; De Cian, Franco; Kaemmerlen, Pierre; Théodore, Christine; Droz, Jean Pierre.

In: Cancer, Vol. 92, No. 3, 01.08.2001, p. 578-587.

Research output: Contribution to journalArticle

Rivoire, Michel ; Elias, Dominique ; De Cian, Franco ; Kaemmerlen, Pierre ; Théodore, Christine ; Droz, Jean Pierre. / Multimodality treatment of patients with liver metastases from germ cell tumors : The role of surgery. In: Cancer. 2001 ; Vol. 92, No. 3. pp. 578-587.
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abstract = "BACKGROUND. The presence of liver metastases represents an independent poor risk prognostic factor for survival in patients with germ cell tumors. METHODS. The clinical files of 37 patients who had undergone liver resection for the treatment of disseminated germ cell tumors were reviewed to define the indications for resection of residual liver metastases after chemotherapy in patients with germ cell tumors. The histologic patterns of primary tumor and residual disease were compared. The prognostic factors for survival were studied by univariate analysis. RESULTS. All but 2 of 37 patients underwent complete resection. One patient died of postoperative complications. Thirteen complications occurred in 10 patients. Twelve patients had active residual tumor, 7 patients had mature teratoma, and 18 patients had only necrosis on histologic examination. Twenty-three of 37 patients (62{\%}) were alive with no evidence of disease after a median follow-up of 66 months (range, 31-134 months). Three prognostic factors were found to be significant in the univariate analysis for unfavorable outcome: The presence of pure embryonal carcinoma in the primary tumor, liver metastases measuring > 30 mm in greatest dimension at the time of surgery, and the presence of viable, active residual disease. C0NCLUSIONS. Because it is impossible to determine the histologic pattern of residual liver masses after chemotherapy with current imaging tools and percutaneous biopsy, patient selection for liver surgery may be undertaken according to the size of residual liver masses. Patients with masses that measure ≤ 10 mm in greatest dimension should be considered for close follow-up, because they have a high probability of necrosis and are at low risk for malignant disease. Male patients with masses that measure ≥ 30 mm in greatest dimension represent a high-risk group of patients who are not likely to benefit from liver surgery. Only male patients with masses that measure 10-29 mm in greatest dimension and all female patients with masses that measure > 10 mm in greatest dimension should be considered for liver resection.",
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AU - Elias, Dominique

AU - De Cian, Franco

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AU - Théodore, Christine

AU - Droz, Jean Pierre

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N2 - BACKGROUND. The presence of liver metastases represents an independent poor risk prognostic factor for survival in patients with germ cell tumors. METHODS. The clinical files of 37 patients who had undergone liver resection for the treatment of disseminated germ cell tumors were reviewed to define the indications for resection of residual liver metastases after chemotherapy in patients with germ cell tumors. The histologic patterns of primary tumor and residual disease were compared. The prognostic factors for survival were studied by univariate analysis. RESULTS. All but 2 of 37 patients underwent complete resection. One patient died of postoperative complications. Thirteen complications occurred in 10 patients. Twelve patients had active residual tumor, 7 patients had mature teratoma, and 18 patients had only necrosis on histologic examination. Twenty-three of 37 patients (62%) were alive with no evidence of disease after a median follow-up of 66 months (range, 31-134 months). Three prognostic factors were found to be significant in the univariate analysis for unfavorable outcome: The presence of pure embryonal carcinoma in the primary tumor, liver metastases measuring > 30 mm in greatest dimension at the time of surgery, and the presence of viable, active residual disease. C0NCLUSIONS. Because it is impossible to determine the histologic pattern of residual liver masses after chemotherapy with current imaging tools and percutaneous biopsy, patient selection for liver surgery may be undertaken according to the size of residual liver masses. Patients with masses that measure ≤ 10 mm in greatest dimension should be considered for close follow-up, because they have a high probability of necrosis and are at low risk for malignant disease. Male patients with masses that measure ≥ 30 mm in greatest dimension represent a high-risk group of patients who are not likely to benefit from liver surgery. Only male patients with masses that measure 10-29 mm in greatest dimension and all female patients with masses that measure > 10 mm in greatest dimension should be considered for liver resection.

AB - BACKGROUND. The presence of liver metastases represents an independent poor risk prognostic factor for survival in patients with germ cell tumors. METHODS. The clinical files of 37 patients who had undergone liver resection for the treatment of disseminated germ cell tumors were reviewed to define the indications for resection of residual liver metastases after chemotherapy in patients with germ cell tumors. The histologic patterns of primary tumor and residual disease were compared. The prognostic factors for survival were studied by univariate analysis. RESULTS. All but 2 of 37 patients underwent complete resection. One patient died of postoperative complications. Thirteen complications occurred in 10 patients. Twelve patients had active residual tumor, 7 patients had mature teratoma, and 18 patients had only necrosis on histologic examination. Twenty-three of 37 patients (62%) were alive with no evidence of disease after a median follow-up of 66 months (range, 31-134 months). Three prognostic factors were found to be significant in the univariate analysis for unfavorable outcome: The presence of pure embryonal carcinoma in the primary tumor, liver metastases measuring > 30 mm in greatest dimension at the time of surgery, and the presence of viable, active residual disease. C0NCLUSIONS. Because it is impossible to determine the histologic pattern of residual liver masses after chemotherapy with current imaging tools and percutaneous biopsy, patient selection for liver surgery may be undertaken according to the size of residual liver masses. Patients with masses that measure ≤ 10 mm in greatest dimension should be considered for close follow-up, because they have a high probability of necrosis and are at low risk for malignant disease. Male patients with masses that measure ≥ 30 mm in greatest dimension represent a high-risk group of patients who are not likely to benefit from liver surgery. Only male patients with masses that measure 10-29 mm in greatest dimension and all female patients with masses that measure > 10 mm in greatest dimension should be considered for liver resection.

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KW - Liver surgery

KW - Postchemotherapy surgery

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