Low-volume nodal metastases detected at retroperitoneal lymphadenectomy for testicular cancer: Pattern and prognostic factors for relapse Journal Article


Authors: Rabbani, F.; Sheinfeld, J.; Farivar-Mohseni, H.; Leon, A.; Rentzepis, M. J.; Reuter, V. E.; Herr, H. W.; Mccaffrey, J. A.; Motzer, R. J.; Bajorin, D. F.; Bosl, G. J.
Article Title: Low-volume nodal metastases detected at retroperitoneal lymphadenectomy for testicular cancer: Pattern and prognostic factors for relapse
Abstract: Purpose: To determine the incidence, pattern, and predictive factors for relapse in patients with low-volume nodal metastases (stage pN1) at retroperitaneal lymphadenectomy (RPLND) and identify who may benefit from chemotherapy in the adjuvant or primary setting. Patients and Methods: Fifty-four patients with testicular nonseminomatous germ cell tumor had low-volume retroperitoneal metastases (pathologic stage pN 1, 1997 tumor-node-metastasis classification) resected at RPLND, 50 of whom were managed expectantly without adjuvant chemotherapy. The dissection was bilateral in 12 and was a modified template in 38 patients. Retroperitoneal metastases were limited to microscopic nodal involvement in 14 patients. Follow-up ranged from 1 to 106 months (median, 31.4 months). Results: Eleven patients (22%) suffered a relapse at a median follow-up of 1.8 months (range, 0.6 ta 28 months). The most frequent form of recurrence was marker elevation in nine (18%) patients. Persistent marker elevation after orchiectomy and before retroperitoneal lymphadenectomy was a significant independent predictor of relapse (relative risk, 8.0; 95% confidence interval, 2.3 to 27.8; P = .001). Four of five (80%) patients with elevated markers (alpha-fetoprotein alone in three, alpha-fetoprotein and beta human chorionic gonadotropin in one) suffered a relapse, compared with seven of 45 (15.6%) patients with normal markers. Conclusion: Clinical stage I and IIA patients with normal markers who have low-volume nodal metastases have a low incidence of relapse and can be managed by observation only if compliance can be assured. In contrast, patients with elevated markers before retroperitoneal lymphadenectomy have a high rate of relapse and should be considered for primary chemotherapy. © 2001 by American Society of Clinical Oncology.
Keywords: adolescent; adult; cancer chemotherapy; human tissue; disease-free survival; middle aged; cancer surgery; major clinical study; cancer recurrence; patient selection; antineoplastic agents; united states; chemotherapy, adjuvant; cancer staging; lymph node metastasis; antineoplastic agent; cancer diagnosis; paraaortic lymph node; lymphatic metastasis; lymph node excision; lymphadenectomy; neoplasm recurrence, local; proportional hazards models; risk; testicular neoplasms; orchiectomy; testis cancer; chorionic gonadotropin beta subunit; alpha fetoprotein; retroperitoneal space; germinoma; actuarial analysis; humans; prognosis; human; male; priority journal; article
Journal Title: Journal of Clinical Oncology
Volume: 19
Issue: 7
ISSN: 0732-183X
Publisher: American Society of Clinical Oncology  
Date Published: 2001-04-01
Start Page: 2020
End Page: 2025
Language: English
PUBMED: 11283135
PROVIDER: scopus
DOI/URL:
Notes: Export Date: 21 May 2015 -- Source: Scopus
Citation Impact
MSK Authors
  1. Dean Bajorin
    658 Bajorin
  2. Robert Motzer
    1243 Motzer
  3. Farhang Rabbani
    84 Rabbani
  4. Joel Sheinfeld
    254 Sheinfeld
  5. Victor Reuter
    1228 Reuter
  6. Harry W Herr
    594 Herr
  7. George Bosl
    430 Bosl