title: Clinical stage I nonseminomatous germ cell tumors of testis. Observation vs retroperitoneal lymph node dissection.
abstract: Between 1980 and 1989, 186 patients with testicular tumors were seen at Roswell Park Memorial Institute. Of these, 66.6 percent (124/186) were diagnosed to have nonseminomatous germ cell tumors (NSGT) and 22 percent (41/186) were clinically determined to have Stage I disease. Patients with clinical Stage I NSGT either underwent observation or retroperitoneal lymph node dissection (RPLND). Recurrence in the observation group of patients was 23.5 percent (4/17) between four and eighteen months (mean 10 months) with the retroperitoneum being the most common site. All but 1 patient (80%) were salvaged with platinum-based combination chemotherapy. Of the 24 patients who had RPLND, 21 percent (5/24) had a false-negative metastatic evaluation. All the patients who had surgically documented metastatic disease were successfully treated with chemotherapy. The similar recurrence rates in the observation group and the false-negative RPLND group suggest that the failure rate in the observation group is a result of the inability to stage accurately patients with NSGT. RPLND continues to be the standard therapy in patients with clinical Stage I disease. Despite its high recurrence rate, observation should, however, be offered to well-motivated and selected patients since salvage platinum-based combination chemotherapy is very effective and the majority of patients in this group are spared a major operative procedure.
authors.affiliation: Department of Urologic Oncology, Roswell Park Memorial Institute, Buffalo, New York.
authors.forename: S K
authors.initials: SK
authors.lastname: Sujka
authors.forename: R P
authors.initials: RP
authors.lastname: Huben
mesh_terms: D000328:Adult; D003131:Combined Modality Therapy; D006801:Humans; D008197:Lymph Node Excision / Q000379:methods; D008297:Male; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local; D009367:Neoplasm Staging; D009373:Neoplasms, Germ Cell and Embryonal / Q000473:pathology / Q000556:secondary / Q000628:therapy*; D011446:Prospective Studies; D012187:Retroperitoneal Space; D013736:Testicular Neoplasms / Q000473:pathology / Q000628:therapy*