The total number of retroperitoneal lymph nodes resected impacts clinical outcome after chemotherapy for metastatic testicular cancer Journal Article


Authors: Carver, B. S.; Cronin, A. M.; Eggener, S.; Savage, C. J.; Motzer, R. J.; Bajorin, D.; Bosl, G. J.; Sheinfeld, J.
Article Title: The total number of retroperitoneal lymph nodes resected impacts clinical outcome after chemotherapy for metastatic testicular cancer
Abstract: Objectives: To evaluate the prognostic significance of the total number of lymph nodes obtained at postchemotherapy retroperitoneal lymph node dissection (PC-RPLND). After the multidisciplinary management of metastatic germ cell tumor, approximately 10%-15% of patients with the histologic finding of fibrosis or teratoma will suffer disease recurrence. Methods: Between 1989 and 2006, a total of 628 patients underwent PC-RPLND and were found to have either fibrosis or teratoma. After Institutional Review Board approval, complete clinical and pathologic data were obtained from our prospective testis cancer surgical database. A Cox proportional hazards regression model was constructed to evaluate the association of the total number of lymph nodes obtained at PC-RPLND on disease recurrence. Results: On pathologic evaluation, 248 (57%) patients had fibrosis and 184 (43%) patients had teratoma. The median number of lymph nodes resected was 25 (interquartile range, 15-37). On multivariable analysis, increasing postchemotherapy nodal size and decreasing lymph node counts were significant predictors of disease recurrence (P = .01, .04, respectively). For patients with 10 nodes removed, the predicted 2-year relapse free probability was 90%, compared with 97% when 50 nodes were removed. Conclusions: Our data suggest that the total number of lymph nodes removed and analyzed is an independent predictor of disease recurrence after PC-RPLND. This has implications both for the urologist to assure completeness of resection and for the pathologist to meticulously assess the pathologic specimens. © 2010 Elsevier Inc. All rights reserved.
Keywords: immunohistochemistry; adult; cancer chemotherapy; controlled study; treatment outcome; survival analysis; retrospective studies; young adult; major clinical study; histopathology; cancer recurrence; chemotherapy, adjuvant; outcome assessment; lymph node metastasis; antineoplastic agent; paraaortic lymph node; lymph nodes; lymphatic metastasis; neoplasm staging; lymph node excision; lymphadenectomy; linear models; cohort studies; proportional hazards models; risk assessment; fibrosis; probability; biopsy, needle; testicular neoplasms; cancer relapse; teratoma; multivariate analysis; orchiectomy; testis cancer; databases, factual; germ cell tumor; retroperitoneal space; testis teratoma
Journal Title: Urology
Volume: 75
Issue: 6
ISSN: 0090-4295
Publisher: Elsevier Science, Inc.  
Date Published: 2010-06-01
Start Page: 1431
End Page: 1435
Language: English
DOI: 10.1016/j.urology.2009.11.076
PUBMED: 20299079
PROVIDER: scopus
PMCID: PMC3654386
DOI/URL:
Notes: --- - "Export Date: 20 April 2011" - "CODEN: URGYA" - "Source: Scopus"
Altmetric Score
MSK Authors
  1. Caroline Savage
    80 Savage
  2. Dean Bajorin
    416 Bajorin
  3. Robert Motzer
    769 Motzer
  4. Joel Sheinfeld
    197 Sheinfeld
  5. Angel M Cronin
    145 Cronin
  6. Brett Stewart Carver
    109 Carver
  7. George Bosl
    270 Bosl
  8. Scott Egon Eggener
    35 Eggener