Pathologic findings and clinical outcome of patients undergoing retroperitonial lymph node dissection after multiple chemotherapy regimens for metastatic testicular germ cell tumors Journal Article

  

Authors:	Eggener, S. E.; Carver, B. S.; Loeb, S.; Kondagunta, G. V.; Bosl, G. J.; Sheinfeld, J.
Article Title:	Pathologic findings and clinical outcome of patients undergoing retroperitonial lymph node dissection after multiple chemotherapy regimens for metastatic testicular germ cell tumors
Abstract:	BACKGROUND. Postchemotherapy surgery is an essential component in the management of patients with metastatic germ cell tumors (GCT). The authors assessed their institutional experience of retroperitoneal lymph node dissection (RPLND) after multiple chemotherapy regimens for advanced GCT. METHODS. By analyzing the institutional prospective surgical database from 1989 to 2004, 71 patients were identified who underwent RPLND after multiple chemotherapy regimens. Clinicopathologic and treatment trends were characterized, and predictors of disease-specific survival (DSS) were evaluated. RESULTS. The histologic findings at RPLND were fibrosis in 36 men (51%), GCT in 20 men (28%), and teratoma in 15 men (21%). Patients who underwent RPLND from 1989 to 1998 (n = 47), compared with patients who underwent RPLND from 1999 to 2004 (n = 24) were more likely to have GCT (36% vs 13%; P = .04). Patients who received taxane-containing chemotherapy regimens as salvage therapy had lower rates of GCT at RPLND (14% vs 42%; P = .01), higher rates of fibrosis (63% vs 39%; P = .04), and similar rates of teratoma (31% vs 33%; P = .9). The 5- and 10-year DSS rates were 74% (95% confidence interval [95% CI], 62-86%) and 70% (95% CI, 56-84%), respectively. Five-year DSS based on worst histology of RPLND and extraretroperitoneal specimens was 87% (95% CI, 75-99%) for fibrosis, 87% for teratoma (95% CI, 63-100%), and 47% for GCT (95% CI, 23-71%; P = .004). On multivariable analysis, retroperitoneal mass ≥5 cm and GCT were predictors of worse DSS (P = .03 and P = .005, respectively). CONCLUSIONS. Taxane-based salvage chemotherapeutic regimens appear to have decreased the rate of GCT at RPLND. The current data support RPLND in select patients after salvage chemotherapy, because a considerable proportion has teratoma or GCT, and the 10-year DSS rate after resection is 70%. © 2006 American Cancer Society.
Keywords:	adolescent; adult; cancer survival; human tissue; treatment outcome; middle aged; survival rate; major clinical study; histopathology; salvage therapy; cisplatin; advanced cancer; cancer combination chemotherapy; paclitaxel; combined modality therapy; chemotherapy; antineoplastic agent; lymph node dissection; paraaortic lymph node; lymphatic metastasis; prospective study; lymph node excision; prospective studies; carboplatin; etoposide; antineoplastic combined chemotherapy protocols; combination chemotherapy; cyclophosphamide; vincristine; ifosfamide; fibrosis; cancer size; testicular neoplasms; dactinomycin; bleomycin; teratoma; multivariate analysis; retroperitoneal neoplasms; taxane derivative; germ cell tumor; retroperitoneal lymph node dissection; metastatic
Journal Title:	Cancer
Volume:	109
Issue:	3
ISSN:	0008-543X
Publisher:	Wiley Blackwell
Date Published:	2007-02-01
Start Page:	528
End Page:	535
Language:	English
DOI:	10.1002/cncr.22440
PUBMED:	17177200
PROVIDER:	scopus
DOI/URL:	http://www.scopus.com/inward/record.url?eid=2-s2.0-33846675812&partnerID=40&md5=eaabea9581b214a0b7d615b683875e84
Notes:	--- - "Cited By (since 1996): 15" - "Export Date: 17 November 2011" - "CODEN: CANCA" - "Source: Scopus"

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