title: Results and outcome of retroperitoneal lymph node dissection for clinical stage I embryonal carcinoma--predominant testis cancer.
abstract: OBJECTIVE
  To determine the incidence of metastatic disease and usage of chemotherapy (adjuvant or metastatic) after primary retroperitoneal lymph node dissection (RPLND) in patients with clinical stage (CS) I embryonal carcinoma (EC)-predominant testicular cancer. EC predominance was defined as the presence of EC at a level greater than that of any other histologic diagnosis.
  
  
  METHODS
  All CS I patients with nonseminomatous germ cell tumors who underwent RPLND at Indiana University from 1990 to 1995 were reviewed retrospectively.
  
  
  RESULTS
  Two-year follow-up was available for 292 of 320 patients. EC-predominant disease was found in 125 (42.8%) of 292. Eighty-five (68.0%) of 125 patients with EC-predominant disease had pathologic stage (PS) I, and 18 (21.2%) of this group of 85 relapsed. A significantly lower PS I relapse rate of 3% was found for patients who had non-EC-predominant disease (P <.0001). PS II disease was more frequent in patients with EC predominance, as 40 (32.0%) of 125 had retroperitoneal metastases, compared with 26 (15.6%) of 167 patients with a non-EC-predominant histologic diagnosis (P =.0024). Chemotherapy was administered to 48 (38.4%) of the 125 patients with CS I EC-predominant disease after RPLND. This included 25 CS I patients with PS II disease who received adjuvant chemotherapy in addition to 23 patients who subsequently required chemotherapy for relapse after RPLND. Ten (66. 6%) of 15 PS II EC-predominant patients were cured by surgery alone. Currently, all 125 EC-predominant patients are disease-free.
  
  
  CONCLUSIONS
  Patients with CS I EC-predominant disease are at a relatively high risk for metastatic disease.
authors.affiliation: Department of Medicine, Division of Hematology/Oncology, Indiana University Medical Center, Indianapolis, USA. chsweene@iupui
authors.forename: C J
authors.initials: CJ
authors.lastname: Sweeney
authors.forename: B P
authors.initials: BP
authors.lastname: Hermans
authors.forename: D K
authors.initials: DK
authors.lastname: Heilman
authors.forename: R S
authors.initials: RS
authors.lastname: Foster
authors.forename: J P
authors.initials: JP
authors.lastname: Donohue
authors.forename: L H
authors.initials: LH
authors.lastname: Einhorn
mesh_terms: D000328:Adult; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use*; D018236:Carcinoma, Embryonal / Q000188:drug therapy* / Q000556:secondary / Q000601:surgery; D017024:Chemotherapy, Adjuvant; D006801:Humans; D015994:Incidence; D008197:Lymph Node Excision; D008297:Male; D009362:Neoplasm Metastasis; D009364:Neoplasm Recurrence, Local; D009367:Neoplasm Staging; D012189:Retrospective Studies; D018570:Risk Assessment; D013736:Testicular Neoplasms / Q000188:drug therapy* / Q000473:pathology / Q000601:surgery; D016896:Treatment Outcome