Retroperitoneal lymph node dissection in patients with low stage testicular cancer with embryonal carcinoma predominance and/or lymphovascular invasion Journal Article

  

Authors:	Stephenson, A. J.; Bosl, G. J.; Bajorin, D. F.; Stasi, J.; Motzer, R. J.; Sheinfeld, J.
Article Title:	Retroperitoneal lymph node dissection in patients with low stage testicular cancer with embryonal carcinoma predominance and/or lymphovascular invasion
Abstract:	Purpose: The outcome after primary retroperitoneal lymph node dissection (RPLND) was analyzed in patients with clinical stage I-IIA nonseminomatous germ cell testicular cancer with embryonal carcinoma predominance (ECP) or lymphovascular invasion (LVI). Materials and Methods: Between 1989 and 2002, 267 patients with clinical stage I-IIA non-seminomatous germ cell testicular cancer, and ECP and/or LVI underwent RPLND. Patient information was obtained from a prospective database. Median followup was 53 months. Results: Overall 42% of patients had pathological stage (PS) II disease, of whom 54% had low volume (PN1) disease and 16% had retroperitoneal teratoma. The 5-year progression-free probability was 90% overall, 90% for PS I and 86% for PN1. All patients with relapse were continuously free of disease following standard chemotherapy with or without resection of residual masses and the 10-year actuarial overall survival was 100%. When adjuvant chemotherapy was restricted to patients with PN2 disease, the estimated 5-year relapse rate was 9% and an estimated 72% of patients avoided chemotherapy. Conclusions: The low risk of systemic relapse in patients with PS I and PN1 after RPLND alone combined with the 16% incidence of retroperitoneal teratoma and the favorable morbidity profile supports RPLND over primary chemotherapy for the treatment of patients with low stage disease with ECP and/or LVI who are not candidates for surveillance. An estimated 72% of patients are spared the potential toxicity of chemotherapy if adjuvant therapy is restricted to patients with PN2. After primary RPLND and selective adjuvant chemotherapy late recurrence is distinctly uncommon and long-term cancer control is anticipated in essentially all patients. Copyright © 2005 by American Urological Association.
Keywords:	treatment outcome; survival rate; major clinical study; chemotherapy, adjuvant; cancer staging; recurrence risk; follow up; lymph node metastasis; lymph node dissection; paraaortic lymph node; lymphatic metastasis; neoplasm staging; lymph node excision; neoplasm recurrence, local; cancer invasion; disease progression; testicular neoplasms; cancer relapse; teratoma; neoplasm invasiveness; neoplasms, germ cell and embryonal; orchiectomy; kaplan meier method; testis cancer; testis; embryonal carcinoma; yolk sac tumor; non seminomatous germinoma; chorionic gonadotropin beta subunit; alpha fetoprotein; retroperitoneal space
Journal Title:	Journal of Urology
Volume:	174
Issue:	2
ISSN:	0022-5347
Publisher:	Elsevier Science, Inc.
Date Published:	2005-08-01
Start Page:	557
End Page:	560
Language:	English
DOI:	10.1097/01.ju.0000165163.03805.37
PUBMED:	16006891
PROVIDER:	scopus
DOI/URL:	http://www.scopus.com/inward/record.url?eid=2-s2.0-22144495005&partnerID=40&md5=185f8ffa948a6125151649c890dae29c
Notes:	--- - "Cited By (since 1996): 36" - "Export Date: 24 October 2012" - "CODEN: JOURA" - "Source: Scopus"

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