Low-volume nodal metastases detected at retroperitoneal lymphadenectomy for testicular cancer: pattern and prognostic factors for relapse.
OBJECTIVE
To determine the incidence, pattern, and predictive factors for relapse in patients with low-volume nodal metastases (stage pN1) at retroperitoneal lymphadenectomy (RPLND) and identify who may benefit from chemotherapy in the adjuvant or primary setting.


METHODS
Fifty-four patients with testicular nonseminomatous germ cell tumor had low-volume retroperitoneal metastases (pathologic stage pN1, 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 to 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.


CONCLUSIONS
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.
Department of Urology, Memorial Sloan-Kettering Cancer Center, New York, NY 10021, USA.
F
F
Rabbani
J
J
Sheinfeld
H
H
Farivar-Mohseni
A
A
Leon
M J
MJ
Rentzepis
V E
VE
Reuter
H W
HW
Herr
J A
JA
McCaffrey
R J
RJ
Motzer
D F
DF
Bajorin
G J
GJ
Bosl
D000206:Actuarial Analysis; D000293:Adolescent; D000328:Adult; D000970:Antineoplastic Agents / Q000008:administration & dosage; D017024:Chemotherapy, Adjuvant; D018572:Disease-Free Survival; D018237:Germinoma / Q000188:drug therapy / Q000401:mortality / Q000473:pathology*; D006801:Humans; D008197:Lymph Node Excision / Q000379:methods*; D008207:Lymphatic Metastasis; D008297:Male; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000453:epidemiology / Q000401:mortality / Q000517:prevention & control*; D018579:Patient Selection; D011379:Prognosis; D016016:Proportional Hazards Models; D012187:Retroperitoneal Space; D012306:Risk; D013736:Testicular Neoplasms / Q000188:drug therapy / Q000401:mortality / Q000473:pathology*; D014481:United States / Q000453:epidemiology
D000970:Antineoplastic Agents