Clinical outcome of patients with fibrosis/necrosis at post-chemotherapy retroperitoneal lymph node dissection for advanced germ cell tumors Journal Article


Authors: Mano, R.; Becerra, M. F.; Carver, B. S.; Bosl, G. J.; Motzer, R. J.; Bajorin, D. F.; Feldman, D. R.; Sheinfeld, J.
Article Title: Clinical outcome of patients with fibrosis/necrosis at post-chemotherapy retroperitoneal lymph node dissection for advanced germ cell tumors
Abstract: Purpose Fibrosis accounts for approximately 50% of histological findings at post-chemotherapy retroperitoneal lymph node dissection, and is associated with reported relapse rates of 10% to 15%. We characterized patients with fibrosis at post-chemotherapy retroperitoneal lymph node dissection and identified predictors of adverse outcomes in this group. Materials and Methods We reviewed the medical records of men who underwent post-chemotherapy retroperitoneal lymph node dissection between 1989 and 2013 with histological findings of necrosis/fibrosis. With few exceptions post-chemotherapy retroperitoneal lymph node dissection after 1999 was performed with a bilateral template. Clinical, pathological and treatment related data were reported. Cox regression models were built to identify predictors of disease recurrence. Results The study cohort included 598 men with a median age of 32 years (IQR 25–38). Most cases (397 of 547, 73%) were classified as IGCCCG good risk, with no significant differences in risk classification before and after 1999 (p=0.55). Median followup was 7.3 years (IQR 3.2–12.3). The 5-year recurrence-free and overall survival rates were 94% and 96%, respectively. Overall 36 patients had disease recurrence, most of which was distant or outside the retroperitoneal lymph node dissection template. Procedures performed after 1999 and the presence of embryonal cell carcinoma on primary histology were associated with improved recurrence-free survival on multivariate analysis (p <0.01). Conclusions Disease recurrence in patients with fibrosis at post-chemotherapy retroperitoneal lymph node dissection is an uncommon yet significant event, which is less likely to occur in patients treated after 1999 and in those with embryonal carcinoma on primary histology. © 2017 American Urological Association Education and Research, Inc.
Keywords: lymph node excision; neoplasms; fibrosis; germ cell and embryonal
Journal Title: Journal of Urology
Volume: 197
Issue: 2
ISSN: 0022-5347
Publisher: Elsevier Science, Inc.  
Date Published: 2017-02-01
Start Page: 391
End Page: 397
Language: English
DOI: 10.1016/j.juro.2016.09.113
PROVIDER: scopus
PMCID: PMC5241176
PUBMED: 27720783
DOI/URL:
Notes: Article -- Export Date: 2 February 2017 -- Source: Scopus
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MSK Authors
  1. Dean Bajorin
    416 Bajorin
  2. Robert Motzer
    769 Motzer
  3. Darren Richard Feldman
    172 Feldman
  4. Joel Sheinfeld
    197 Sheinfeld
  5. Brett Stewart Carver
    109 Carver
  6. George Bosl
    270 Bosl
  7. Roy Mano
    24 Mano
  8. Maria Fernanda   Becerra
    15 Becerra