Primary retroperitoneal lymph node dissection in low-stage testicular germ cell tumors: A detailed pathologic study with clinical outcome analysis with special emphasis on patients who did not receive adjuvant therapy Journal Article


Authors: Al-Ahmadie, H. A.; Carver, B. S.; Cronin, A. M.; Olgac, S.; Tickoo, S. K.; Fine, S. W.; Gopalan, A.; Stasi, J.; Rabbani, F.; Bosl, G. J.; Sheinfeld, J.; Reuter, V. E.
Article Title: Primary retroperitoneal lymph node dissection in low-stage testicular germ cell tumors: A detailed pathologic study with clinical outcome analysis with special emphasis on patients who did not receive adjuvant therapy
Abstract: Objective To evaluate, in detail, the histopathologic features of metastatic testicular germ cell tumors to retroperitoneal lymph nodes treated with primary retroperitoneal lymph node dissection (RPLND) and correlate the findings with patients' outcomes. Materials and Methods We studied 183 patients with documented pathologic stage II disease with or without elevated serum tumor markers, selected from 453 patients who underwent primary RPLND at our institution from 1989 to 2002. Tumor type(s), size and extent of disease, and amount of tumor necrosis were assessed and correlated with outcome. Results Embryonal carcinoma was the most common tumor type, present as the only component in 99 cases (54%) and the predominant tumor type (>50%) in 142 (78%). The number of positive lymph nodes ranged from 1 to 40 from a total of 2-80 lymph nodes examined (median, 28). Extranodal extension (ENE) was identified in 120 cases (66%). Among 73 patients followed up expectantly and with normal serum tumor markers, 19 experienced relapse, the probability of which was higher in patients with more positive nodes, larger metastases, and presence of ENE. However, none of these differences was statistically significant (all P >.2). The predominance of embryonal carcinoma and the presence of tumor necrosis were not significantly associated with outcome. Conclusion In this cohort, most patients treated with primary RPLND and with positive lymph nodes also had ENE. We did not identify any variables to be significantly associated with relapse after RPLND in patients managed expectantly. Additional studies with more patients are needed to validate our findings. © 2013 Elsevier Inc. All Rights Reserved.
Keywords: human tissue; treatment outcome; major clinical study; histopathology; cisplatin; cancer staging; follow up; lymph node dissection; paraaortic lymph node; metastasis; multiple cycle treatment; tumor volume; etoposide; tumor marker; correlation analysis; statistical significance; tumor recurrence; adjuvant chemotherapy; germ cell tumor; embryonal carcinoma; tumor necrosis; prognosis; human; male; priority journal; article
Journal Title: Urology
Volume: 82
Issue: 6
ISSN: 0090-4295
Publisher: Elsevier Science, Inc.  
Date Published: 2013-01-01
Start Page: 1341
End Page: 1347
Language: English
DOI: 10.1016/j.urology.2013.04.082
PROVIDER: scopus
PUBMED: 24094656
DOI/URL:
Notes: Export Date: 2 January 2014 -- CODEN: URGYA -- Source: Scopus
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MSK Authors
  1. Farhang Rabbani
    82 Rabbani
  2. Semra Olgac
    98 Olgac
  3. Satish K Tickoo
    370 Tickoo
  4. Anuradha Gopalan
    275 Gopalan
  5. Joel Sheinfeld
    197 Sheinfeld
  6. Angel M Cronin
    145 Cronin
  7. Brett Stewart Carver
    109 Carver
  8. Samson W Fine
    316 Fine
  9. Victor Reuter
    922 Reuter
  10. George Bosl
    270 Bosl
  11. Jason Stasi
    25 Stasi