Advanced metastatic XXXX : the need for reporting results according to initial extent of disease.

@entity1 @entity1625 @entity66 @entity5 @entity358 @entity1732 @entity902 @entity5713
During an 8-year period 63 consecutive @entity1 were treated for the first time for extensive metastatic nonseminomatous @entity5 . Four @entity1 did not respond sufficiently to chemotherapy to be considered surgical candidates, while 59 underwent surgical resection of @entity66 . Of these 59 @entity1 19 had concomitant wedge resection of associated @entity358 and 9 had a planned subsequent resection of residual @entity358 . Of the 63 @entity1 16 had stage B3 disease alone and 47 presented with pulmonary metastases associated with varying degrees of @entity66 . The most important determinant for survival was extent of @entity358 . Of 17 deaths 14 occurred among @entity1 presenting with extensive @entity358 . @entity1 with minimal to moderate @entity358 have done well regardless of the extent of coexistent @entity1625 , 24 of 27 (89 per cent) remaining in sustained complete remission. Of 16 @entity1 with massive palpable @entity1625 (B3) without coexistent pulmonary metastases 15 (94 per cent) survived free of @entity5 . The combination of extensive @entity358 with or without liver involvement has a poor prognosis, with only 35 per cent of these @entity1 remaining in sustained complete remission. Preoperative combination chemotherapy with @entity902 , @entity5713 and @entity1732 has improved survival free of @entity5 in this group compared to other combinations not including @entity902 (47 compared to 20 per cent) but the results in this selected group of @entity1 are significantly worse than those seen for all other @entity1 with lesser extent of disease. @entity5 recurrence more than 9 months after achieving complete remission has not been noted during following to 10 years. A plea is made for cases of advanced disease (B3 and/or C) to be reported according to the extent of @entity358 as well as the associated @entity1625 , since analysis of these data reveals striking differences in @entity1 survival, ranging from 100 to 35 per cent according to subgrouping.
