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
Notes: Export Date: 21 May 2015 -- Source: Scopus