title: Risk of systemic metastases in clinical stage I nonseminoma germ cell testis tumor managed by retroperitoneal lymph node dissection.
abstract: OBJECTIVE
  We assess the risk of systemic recurrence after retroperitoneal lymph node dissection for clinical stage I nonseminoma germ cell testis tumor based on predominance of embryonal carcinoma and/or vascular invasion in the orchiectomy specimen.
  
  
  METHODS
  A total of 292 cases of clinical stage I nonseminoma germ cell testis tumor treated with retroperitoneal lymph node dissection from 1990 to 1995 were identified from the Indiana University database. A minimum of 2 years of followup was required for study entry. Review of the written pathological reports classified tumors as embryonal carcinoma predominant, when it was present at a level greater than any other histology, nonpredominant, when it was present but not as the main histological subtype, and absent. Vascular invasion was categorized as present or absent.
  
  
  RESULTS
  Of the 292 cases 226 (77. 4%) were pathological stage I and relapse rate after retroperitoneal lymph node dissection was 10.2%. Vascular invasion and embryonal carcinoma predominance in the orchiectomy specimen were predictors of relapse in this group. None of the 35 pathological stage II cases treated with adjuvant chemotherapy had relapse, whereas relapse occurred in 7 of 31 pathological stage II cases (22.6%) not treated with adjuvant chemotherapy.
  
  
  CONCLUSIONS
  Pathological stage I cases with predominant embryonal carcinoma and/or vascular invasion in the orchiectomy specimen have a higher probability of systemic recurrence after retroperitoneal lymph node dissection. Dissection alone still has a major therapeutic impact (77%) in patients with clinical stage I, pathological stage II nonseminoma germ cell testis tumor.
authors.affiliation: Department of Urology, Indiana University Medical Center, Indianapolis, Indiana, USA.
authors.forename: B P
authors.initials: BP
authors.lastname: Hermans
authors.forename: C J
authors.initials: CJ
authors.lastname: Sweeney
authors.forename: R S
authors.initials: RS
authors.lastname: Foster
authors.forename: L E
authors.initials: LE
authors.lastname: Einhorn
authors.forename: J P
authors.initials: JP
authors.lastname: Donohue
mesh_terms: D000293:Adolescent; D000328:Adult; D018237:Germinoma / Q000473:pathology* / Q000601:surgery*; D006801:Humans; D008197:Lymph Node Excision; D008207:Lymphatic Metastasis; D008297:Male; D008875:Middle Aged; D009361:Neoplasm Invasiveness; D018570:Risk Assessment; D013736:Testicular Neoplasms / Q000473:pathology* / Q000601:surgery*