Purpose

Choriocarcinoma germ cell tumors are rare and usually present with significantly elevated human chorionic gonadotropin (hCG) levels. When curable, it is felt to be largely a result of chemotherapy. We sought to determine the histologic characteristics for those undergoing postchemotherapy retroperitoneal lymph node dissection (PC-RPLND) and compare them with metastatic nonseminomatous germ cell tumor (NSGCT) patients with similarly elevated hCG levels.

Methods

We reviewed medical records of men undergoing PC-RPLND between 1988 and 2017 with postorchiectomy, preinduction chemotherapy hCG levels greater than 50,000 mIU/ml. They were stratified by primary tumor histology: Pure choriocarcinoma and mixed NSGCT. Clinical, pathologic, and serologic data were reported and logistic regression was used to assess for predictors of necrosis in the PC-RPLND specimen.

Results

Our cohort consisted of 108 men. The mixed group (n = 91) had a median hCG of 165,177 mIU/ml, a postchemotherapy node size of 4.7 cm, of whom 19.8% also received salvage chemotherapy prior to RPLND. The pure choriocarcinoma group (n = 17) had a median hCG of 170,267 mIU/ml, a node size of 5.1 cm, of whom 17.6% received salvage chemotherapy. 88.2% of patients with choriocarcinoma had necrosis in the PC-RPLND specimen compared with 29.7% of the mixed NSGCT group (P = <0.0001). Controlling for salvage chemotherapy use, prechemotherapy hCG, node size and marker status, choriocarcinoma patients were 20 fold more likely to have necrosis on RPLND specimen (Odds ratio 20.68 [95% confidence interval 5.279–81.114]).

Conclusion

While PC-RPLND is appropriate in patients with residual masses after chemotherapy, patients with pure choriocarcinoma presenting with significantly elevated hCG levels represent a unique patient population where necrosis is found more often than anticipated.

中文翻译：

---

HCG水平很高的患者进行化疗后腹膜后淋巴结清扫术。

目的

绒毛膜上皮细胞生殖细胞肿瘤是罕见的，通常与人类绒毛膜促性腺激素（hCG）水平明显升高有关。如果可以治愈，则感觉很大程度上是化学疗法的结果。我们试图确定那些接受化疗后腹膜后淋巴结清扫术（PC-RPLND）的组织学特征，并将其与hCG水平同样升高的转移性非精原细胞生殖细胞瘤（NSGCT）患者进行比较。

方法

我们回顾了1988年至2017年间进行睾丸切除术后，诱导前化疗hCG水平大于50,000 mIU / ml的PC-RPLND男性的病历。按原发肿瘤组织学将其分层：纯绒毛膜癌和混合型NSGCT。报告了临床，病理和血清学数据，并使用逻辑回归分析评估了PC-RPLND标本中坏死的预测因子。

结果

我们的队列由108名人员组成。混合组（n = 9 1）的hCG中位数为165,177 mIU / ml，化疗后结节大小为4.7 cm，其中19.8％的患者在RPLND之前也接受了挽救性化疗。单纯绒毛膜癌组（n = 1 7）的hCG中位数为170,267 mIU / ml，淋巴结大小为5.1 cm，其中17.6％接受了挽救性化疗。PC-RPLND标本中绒毛癌患者中有88.2％坏死，而混合NSGCT组中这一比例为29.7％（P  = <0.0001）。控制挽救性化疗的使用，化疗前的hCG，淋巴结大小和标志物状态，绒毛膜癌患者RPLND标本坏死的可能性高20倍（几率20.68 [95％置信区间5.279-81.114]）。

结论

尽管PC-RPLND适用于化疗后有残余肿块的患者，但单纯hCG水平明显升高的纯绒毛膜癌患者却是独特的患者人群，坏死的发生率比预期的高。