Residual tumour resection in case of elevated markers

In patients with germ cell tumours and elevated serum tumour markers, whether post-chemotherapy residual tumour resection is beneficial is unclear. A retrospective analysis from Germany aimed to better define patients who benefit from surgery in this setting.

By analysing data from their own database, Dr Yue Che (University of Düsseldorf, Germany) and colleagues found 575 post-chemotherapy residual tumour resections, performed in 516 patients, including 153 procedures in patients with elevated serum tumour markers (human chorionic gonadotropin [β-HCG] >2.0 mIU/mL; α-fetoprotein [AFP] >7.0 µg/L). Of these patients, 55 received resection after first-line chemotherapy and 98 after second- or further-line (salvage) chemotherapy [1].

Viable cancer in the resected specimen was more frequently present in the salvage group compared with the first-line group (49% vs 16%; P=0.0002). The presence of viable cancer was a predictor of survival in both groups. In the first-line group, teratoma was the most common type (52.7%), followed by necrosis/fibrosis (30.9%) and viable cancer (16.4%).

Univariate and multivariate regression analysis was performed to determine predictors for residual tumour resection histology and oncological outcome. A preoperative serum level of AFP ≥30 µg/L was a predictor of viable cancer in the first-line group (56%; P=0.016) and in the salvage setting (67%; P=0.0017). The overall relapse-free rate was significantly worse in the salvage group compared with the first-line group (22.7% vs 50%; P=0.00032), as was the survival rate (37.8% vs 65%; P=0.0059). Serum AFP ≥30 µg/L and β-HCG ≥20 mIU/mL were significant factors affecting survival in the first-line group.

Dr Che argued that patients with serum AFP ≥30 µg/L and β-HCG ≥20 mIU/mL after first-line chemotherapy should receive salvage chemotherapy instead of surgery because chances for viable cancer and relapse are high and survival is poor. These patients will probably not benefit from post-chemotherapy residual tumour resection, and salvage chemotherapy should be the preferred treatment. After second- or further-line therapy, the prognosis of patients with elevated markers and surgery is poor, regardless of tumour marker levels. However, 38% of these patients are long-term survivors, which justifies post-chemotherapy residual tumour resection in this setting.

1. Che Y. Post-chemotherapy residual tumor resection in patients with elevated tumor markers. P0662, EAU21 Virtual, 8–12 July 2021.

 

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Posted on 31 August, 2021