Clinical impact of residual extraretroperitoneal masses in patients with advanced nonseminomatous germ cell testicular cancer Journal Article


Authors: Masterson, T. A.; Shayegan, B.; Carver, B. S.; Bajorin, D. F.; Feldman, D. R.; Motzer, R. J.; Bosl, G. J.; Sheinfeld, J.
Article Title: Clinical impact of residual extraretroperitoneal masses in patients with advanced nonseminomatous germ cell testicular cancer
Abstract: Integration of platinum-based chemotherapy and surgical resection of residual masses is essential in the management of advanced nonseminomatous germ cell tumors (NSGCT). We reviewed our institutional experience in patients undergoing resection of extraretroperitoneal (ERP) residual masses after chemotherapy to assess its impact on cancer progression and survival. Between 1989 and 2003, 532 patients with advanced NSGCT underwent postchemotherapy retroperitoneal lymph node dissection (PC-RPLND) with a median follow-up of 41 months. Survival probabilities were estimated by the KaplanMeier method. Cox proportional hazards regression analysis was used to determine the prognostic significance of risk factors for progression and survival. Of 532 patients, 402 (76%) underwent PC-RPLND alone, and 130 (24%) underwent resection of ERP residual disease concurrently or in a staged fashion within 6 weeks. Concordance between retroperitoneal (RP) and ERP sites of disease was 83% in the presence of fibrosis, 42% for teratoma, and 47% for viable NSGCT. Overall, 34% of patients undergoing resection of ERP residual disease had either teratoma or viable disease on final pathology. Five-year probability of freedom from progression was 74% (95% CI 65%, 82%) and disease-specific survival was 84% (95% CI 75%, 89%). On multivariable analysis the histologic findings at the ERP site were significant predictors of disease progression, independent of the RP findings. Our data suggest that teratoma or viable NSGCT is present in approximately one-third of patients undergoing resection of residual ERP disease. The presence of residual ERP teratoma and viable NSGCT predicts for cancer progression independent of RP histology. © 2012 Elsevier Inc.
Journal Title: Urology
Volume: 79
Issue: 1
ISSN: 0090-4295
Publisher: Elsevier Science, Inc.  
Date Published: 2012-01-01
Start Page: 156
End Page: 159
Language: English
DOI: 10.1016/j.urology.2011.09.038
PROVIDER: scopus
PUBMED: 22202548
DOI/URL:
Notes: --- - "Export Date: 1 February 2012" - "CODEN: URGYA" - "Source: Scopus"
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  1. Dean Bajorin
    658 Bajorin
  2. Robert Motzer
    1243 Motzer
  3. Darren Richard Feldman
    342 Feldman
  4. Joel Sheinfeld
    254 Sheinfeld
  5. Brett Stewart Carver
    143 Carver
  6. George Bosl
    430 Bosl