Outcomes in patients with clinical Stage III NSGCT who achieve complete clinical response to chemotherapy at extraretroperitoneal disease site Journal Article

Authors: Masterson, T. A.; Carver, B. S.; Shayegan, B.; Feldman, D. R.; Motzer, R. J.; Bosl, G. J.; Sheinfeld, J.
Article Title: Outcomes in patients with clinical Stage III NSGCT who achieve complete clinical response to chemotherapy at extraretroperitoneal disease site
Abstract: Objective: To compare the survival outcomes of patients with advanced nonseminoma and extraretroperitoneal (ERP) disease observed for a clinical complete response (CCR) with those demonstrating a pathologic complete response (PCR). Methods: From 1989 to 2003, 237 patients with clinical Stage III nonseminoma underwent induction chemotherapy followed by retroperitoneal lymph node dissection. After chemotherapy, 107 demonstrated a CCR to treatment at the ERP disease site. Of the remaining 130 patients with radiographic evidence of residual ERP disease, 86 (66%) had fibrosis only on pathologic review (ie, PCR). The probability of progression-free and disease-specific survival was estimated using the Kaplan-Meier method. Cox proportional hazards regression analysis was used to determine the prognostic significance of risk factors for progression and survival. Results: The median follow-up was similar for both CCR and PCR patients (44.5 and 50.7 months, respectively). Overall, the 5-year probability of freedom from progression (93% vs 72%, respectively; P =.0005) and disease-specific survival (96% vs 87%, respectively; P =.08) rates were far better for men with a PCR. The predictors of disease progression included residual retroperitoneal nodal size after chemotherapy (P =.05), and resection of the residual disease at the ERP site was protective (P =.02). Conclusion: A CCR at the ERP disease site is associated with a greater likelihood of relapse compared with a PCR, underscoring the limitations of radiographic imaging after chemotherapy in detecting microscopic residual disease and need for rigorous monitoring of patients observed after a CCR. Furthermore, until more accurate clinical predictors of ERP histologic features are identified, we advocate for complete surgical resection of all sites of residual disease, when feasible. © 2012 Elsevier Inc.
Keywords: adolescent; adult; human tissue; treatment outcome; treatment response; survival rate; major clinical study; histopathology; cancer localization; cisplatin; advanced cancer; cancer growth; cancer staging; follow up; lymph node metastasis; lymph node dissection; paraaortic lymph node; progression free survival; multiple cycle treatment; etoposide; patient monitoring; diagnostic imaging; risk factor; fibrosis; proportional hazards model; minimal residual disease; bleomycin; cancer relapse; kaplan meier method; germ cell tumor; disease specific survival; induction chemotherapy; nonseminomatous germ cell tumor
Journal Title: Urology
Volume: 79
Issue: 5
ISSN: 0090-4295
Publisher: Elsevier Science, Inc.  
Date Published: 2012-05-01
Start Page: 1079
End Page: 1084
Language: English
DOI: 10.1016/j.urology.2011.11.090
PROVIDER: scopus
PUBMED: 22446341
Notes: --- - "Export Date: 4 June 2012" - "CODEN: URGYA" - "Source: Scopus"
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MSK Authors
  1. Robert Motzer
    769 Motzer
  2. Darren Richard Feldman
    172 Feldman
  3. Joel Sheinfeld
    197 Sheinfeld
  4. Brett Stewart Carver
    109 Carver
  5. George Bosl
    270 Bosl