Prolonged survival after thoracic metastasectomy in patients with nonseminomatous testicular cancer

Abstract

Introduction: Almost 20% of patients with Non-Seminomatous Germinative Cell Tumors (NSGCT) will require intrathoracic metastasectomy after chemotherapy. The authors aim to determine their long-term survival rates. Methods: Retrospective study including patients with NSGCT and intrathoracic metastasis after systemic therapy from January 2011 to June 2022. Treatment outcomes and overall survival were analyzed with the Kaplan-Meier method. Results: Thirty-seven male patients were included with a median age of 31.8 years. Six presented with synchronous mediastinum and lung metastasis, nine had only lung, and 22 had mediastinal metastasis. Over half had retroperitoneal lymph node metastasis. Twenty-two had dissimilar pathologies, with a discordance rate of 62%. Teratoma and embryonal carcinoma were the prevalent primary tumor types, 40.5% each, while teratoma was predominant (70.3%) in the metastasis group. Thoracotomy was the main surgical approach (39.2%) followed by VATS (37.2%), cervico-sternotomy (9.8%), sternotomy (5.8%), and clamshell (3.9%). Lung resection was performed in 40.5% of cases. Overall, 10-year survival rates were 94.3% with no surgical-related mortality. Conclusion: Multimodality treatment with systemic therapy followed by radical surgery offers a high cure rate to patients with intrathoracic metastatic testicular germ cell tumors.