Residual masses after chemotherapy for metastatic testicular cancer: the clinical implications of the association between retroperitoneal and pulmonary histology. Re-analysis of Histology in Testicular Cancer (ReHiT) Study Group.
OBJECTIVE
We determined the need and sequence of retroperitoneal lymph node dissection and thoracotomy in patients with nonseminomatous testicular cancer, and with residual retroperitoneal and pulmonary masses after chemotherapy.


METHODS
We studied 159 patients undergoing retroperitoneal lymph node dissection and a thoracotomy following cisplatin based induction chemotherapy for metastatic testicular nonseminomatous germ cell tumor. Several well-known predictors for residual histology (necrosis, mature teratoma and cancer) were evaluated.


RESULTS
As expected, necrosis was found more often at retroperitoneal lymph node dissection if the primary tumor was negative for teratoma, the residual mass was small or the decrease in size was great. Contrary, neither residual mass size nor the decrease in size was predictive of the histological status of the residual lung lesion. Histological findings in the retroperitoneum and lung were strongly correlated, such that necrosis at retroperitoneal lymph node dissection was associated with an 89% probability of necrosis in the lung.


CONCLUSIONS
Retroperitoneal lymph node dissection should be performed before thoracotomy is considered, since the histological status at dissection is a strong predictor of that at thoracotomy.
Steyerberg
E W
EW
Department of Public Health, Erasmus University, Rotterdam, The Netherlands.
Donohue
J P
JP
Gerl
A
A
Toner
G C
GC
Schraffordt Koops
H
H
Fosså
S D
SD
Keizer
H J
HJ
D018237:Germinoma / Q000188:drug therapy* / Q000473:pathology / Q000556:secondary* / Q000601:surgery; D006801:Humans; D008175:Lung Neoplasms / Q000188:drug therapy* / Q000473:pathology / Q000556:secondary* / Q000601:surgery; D008197:Lymph Node Excision; D008297:Male; D018365:Neoplasm, Residual; D011237:Predictive Value of Tests; D012186:Retroperitoneal Neoplasms / Q000188:drug therapy* / Q000473:pathology / Q000556:secondary* / Q000601:surgery; D012680:Sensitivity and Specificity; D013736:Testicular Neoplasms / Q000188:drug therapy* / Q000473:pathology*; D013908:Thoracotomy