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1.
J Clin Oncol ; 13(5): 1170-6, 1995 May.
Artículo en Inglés | MEDLINE | ID: mdl-7537800

RESUMEN

PURPOSE: This study analyzed a large group of patients with testicular germ cell cancer in complete remission, who relapsed more than 2 years after completion of treatment. PATIENTS AND METHODS: A review of all patients treated at Indiana University Medical Center from 1979 through 1992 for late relapse was conducted. Eighty-one patients were treated for late relapse of testicular cancer. Forty-seven patients relapsed more than 5 years after successful management of their initial disease. RESULTS: At initial diagnosis, 35 patients had clinical stage I, 18 stage II, and 28 stage III disease. Twenty-three of 35 stage I, all 18 stage II, and all 28 stage III patients were treated by chemotherapy before their late relapse. The median follow-up duration of patients post-management of late relapse was 4.8 years. Twenty-one patients (25.9%) are continuously disease-free. Nineteen of these 21 patients had surgical resection of carcinoma or teratoma as a component of their therapy. Of sixty-five patients treated for late relapse by chemotherapy, 17 (26.2%) had a complete response, but only two have been continuously disease-free with chemotherapy alone. These two never received prior chemotherapy. CONCLUSION: Late relapse of testis cancer is more common than previously thought. Surgery is the preferred mode of therapy. Chemotherapy has only modest success in this entity, in contrast to the excellent results in de novo germ cell tumors. Patients treated for testicular germ cell cancer need annual follow-up evaluations throughout their life due to the possibility of late relapse.


Asunto(s)
Recurrencia Local de Neoplasia/terapia , Neoplasias Testiculares/terapia , Adolescente , Adulto , Análisis de Varianza , Biomarcadores de Tumor , Carcinoma Embrionario/patología , Carcinoma Embrionario/secundario , Carcinoma Embrionario/terapia , Supervivencia sin Enfermedad , Estudios de Seguimiento , Humanos , Incidencia , Metástasis Linfática , Masculino , Recurrencia Local de Neoplasia/diagnóstico , Recurrencia Local de Neoplasia/epidemiología , Recurrencia Local de Neoplasia/mortalidad , Estadificación de Neoplasias , Orquiectomía , Seminoma/patología , Seminoma/secundario , Seminoma/terapia , Teratoma/patología , Teratoma/secundario , Teratoma/terapia , Neoplasias Testiculares/mortalidad , Neoplasias Testiculares/patología , alfa-Fetoproteínas/análisis
2.
J Clin Oncol ; 13(5): 1177-87, 1995 May.
Artículo en Inglés | MEDLINE | ID: mdl-7537801

RESUMEN

PURPOSE: To develop a statistical model that predicts the histology (necrosis, mature teratoma, or cancer) after chemotherapy for metastatic nonseminomatous germ cell tumor (NSGCT). PATIENTS AND METHODS: An international data set was collected comprising individual patient data from six study groups. Logistic regression analysis was used to estimate the probability of necrosis and the ratio of cancer and mature teratoma. RESULTS: Of 556 patients, 250 (45%) had necrosis at resection, 236 (42%) had mature teratoma, and 70 (13%) had cancer. Predictors of necrosis were the absence of teratoma elements in the primary tumor, prechemotherapy normal alfa-fetoprotein (AFP), normal human chorionic gonadotropin (HCG), and elevated lactate dehydrogenase (LDH) levels, a small prechemotherapy or postchemotherapy mass, and a large shrinkage of the mass during chemotherapy. Multivariate combination of predictors yielded reliable models (goodness-of-fit tests, P > .20), which discriminated necrosis well from other histologies (area under the receiver operating characteristic (ROC) curve, .84), but which discriminated cancer only reasonably from mature teratoma (area, .66). Internal and external validation confirmed these findings. CONCLUSION: The validated models estimate with high accuracy the histology at resection, especially necrosis, based on well-known and readily available predictors. The predicted probabilities may help to choose between immediate resection of a residual mass or follow-up, taking into account the expected benefits and risks of resection, feasibility of frequent follow-up, the financial costs, and the patient's individual preferences.


Asunto(s)
Germinoma/patología , Germinoma/secundario , Neoplasias Retroperitoneales/patología , Neoplasias Retroperitoneales/secundario , Teratoma/patología , Neoplasias Testiculares/patología , Análisis de Varianza , Gonadotropina Coriónica/sangre , Estudios de Seguimiento , Germinoma/sangre , Germinoma/terapia , Humanos , L-Lactato Deshidrogenasa/sangre , Modelos Logísticos , Masculino , Análisis Multivariante , Necrosis , Neoplasia Residual , Valor Predictivo de las Pruebas , Probabilidad , Curva ROC , Reproducibilidad de los Resultados , Neoplasias Retroperitoneales/sangre , Neoplasias Retroperitoneales/terapia , Teratoma/secundario , Neoplasias Testiculares/sangre , Neoplasias Testiculares/tratamiento farmacológico , alfa-Fetoproteínas/análisis
3.
J Urol ; 155(2): 587-9, 1996 Feb.
Artículo en Inglés | MEDLINE | ID: mdl-8558665

RESUMEN

PURPOSE: We reviewed our experience with patients who had nonseminomatous germ cell tumors clinically limited to the testis and persistently elevated serum human chorionic gonadotropin (HCG) or alpha-fetoprotein (AFP) levels after orchiectomy. MATERIALS AND METHODS: All patients had clinical stage I disease with persistently elevated tumor markers that were not decreasing in accordance with the expected metabolic decay rate at retroperitoneal lymph node dissection. RESULTS: Of 30 patients identified 3 had elevated AFP, 24 had elevated HCG and 3 had elevation of both markers. Of the 6 patients with elevated AFP with or without concurrent HCG elevation 5 (83%) had relapse and required chemotherapy, as did 6 of 24 (25%) with HCG elevation. CONCLUSIONS: Patients with persistently elevated AFP after orchiectomy should be treated initially with chemotherapy. Although the majority of patients with elevated serum HCG were disease-free after surgery alone, a fourth of these patients still had relapse and required chemotherapy.


Asunto(s)
Gonadotropina Coriónica/sangre , Germinoma/sangre , Germinoma/cirugía , Orquiectomía , Neoplasias Testiculares/sangre , Neoplasias Testiculares/cirugía , alfa-Fetoproteínas/análisis , Adolescente , Adulto , Estudios de Seguimiento , Germinoma/patología , Humanos , Escisión del Ganglio Linfático , Masculino , Estadificación de Neoplasias , Factores de Riesgo , Neoplasias Testiculares/patología
4.
Mod Pathol ; 7(1): 64-8, 1994 Jan.
Artículo en Inglés | MEDLINE | ID: mdl-7909155

RESUMEN

Sixty-nine cases of clinical Stage I non-seminomatous germ cell tumors (NSGCT) of the testis were immunostained for the protein product of the p53 tumor suppressor gene using a microwave-based antigen retrieval method. It was assumed that the immunohistochemical detection of the p53 protein corresponded to a point mutation in the p53 gene, the wild-type p53 protein turning over too rapidly to be detected by routine immunohistochemical techniques. The results of p53 staining were then compared with the results, on the same paraffin tissue blocks, of S-phase analysis, as determined by flow cytometry, and the percentage of neoplastic cells exhibiting immunohistochemical positivity for proliferating cell nuclear antigen (PCNA). Thirty-four of 69 (49%) of the clinical Stage I NSGCT exhibited p53-positivity as strong, but focal, intranuclear positivity. Both the mean total S-phase and the mean percentage of PCNA-positive neoplastic cells were significantly higher in the p53-positive cases (27.8% and 89.6%, respectively) compared with the p53-negative cases (17.6% and 66.1%, respectively). Stratification of cases into high (> or = 76%) and low categories for PCNA values correlated significantly (P < 0.0005) with p53-positivity and negativity, respectively, by chi 2 analysis. The positive association of p53 protein expression with higher proliferative indices in NSGCT of the testis is consistent with the observation of p53 mutations correlating with markers of increased tumor aggressiveness in other types of neoplasia.(ABSTRACT TRUNCATED AT 250 WORDS)


Asunto(s)
Germinoma/patología , Neoplasias Testiculares/patología , Proteína p53 Supresora de Tumor/biosíntesis , ADN de Neoplasias , Germinoma/química , Germinoma/secundario , Humanos , Masculino , Invasividad Neoplásica , Estadificación de Neoplasias , Proteínas Nucleares/análisis , Antígeno Nuclear de Célula en Proliferación , Neoplasias Testiculares/química
5.
Cancer ; 79(2): 345-55, 1997 Jan 15.
Artículo en Inglés | MEDLINE | ID: mdl-9010108

RESUMEN

BACKGROUND: After chemotherapy for a metastatic nonseminomatous germ cell tumor, pulmonary masses may be seen on a computed tomography scan. These residual masses may contain one of three histologic elements: necrosis, mature teratoma, or cancer. Because surgical resection of masses containing only necrosis is unnecessary, the authors aimed to predict the histology of these residual masses. METHODS: Six study groups contributed patient data on a total of 215 patients undergoing thoracotomy after cisplatin-based induction chemotherapy for metastatic testicular nonseminomatous germ cell tumors. Logistic regression analysis was used to estimate the probability of necrosis, mature teratoma, and cancer in relation to predictors known before thoracotomy. RESULTS: The pulmonary mass histology was necrosis in 116 patients (54%), mature teratoma in 70 (33%), and cancer in 29 (13%). Necrosis was found at thoracotomy in 89% of those patients with necrosis at retroperitoneal lymph node dissection (RPLND). Other predictors included the primary tumor histology, prechemotherapy tumor marker levels, change in mass size during chemotherapy, and the presence of a single, unilateral mass. Multivariate combination of predictors yielded reliable models (goodness-of-fit tests, P > 0.20), which discriminated necrosis well from other histologies, especially if RPLND histology was available (area under the receiver operating characteristic curve, 0.86). CONCLUSIONS: This analysis indicated subgroups of patients with a high probability of necrosis and a low risk of cancer for whom close follow-up of the residual pulmonary mass might be considered. In most patients, a RPLND should be performed before a thoracotomy is considered, because the probability of necrosis is generally higher at thoracotomy than at RPLND and the histology at RPLND is a strong predictor of the histology at thoracotomy.


Asunto(s)
Germinoma/patología , Germinoma/secundario , Neoplasias Pulmonares/patología , Neoplasias Pulmonares/secundario , Teratoma/patología , Teratoma/secundario , Neoplasias Testiculares/patología , Análisis de Varianza , Biomarcadores de Tumor/sangre , Gonadotropina Coriónica/sangre , Germinoma/sangre , Germinoma/tratamiento farmacológico , Germinoma/cirugía , Humanos , L-Lactato Deshidrogenasa/sangre , Neoplasias Pulmonares/sangre , Neoplasias Pulmonares/tratamiento farmacológico , Neoplasias Pulmonares/cirugía , Masculino , Necrosis , Teratoma/sangre , Teratoma/tratamiento farmacológico , Teratoma/cirugía , alfa-Fetoproteínas/análisis
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