title: Clinical parameters that predict histology of postchemotherapy retroperitoneal lymph node mass in testicular cancer.
abstract: BACKGROUND
  Since the advent of cisplatin-based chemotherapy, the majority of metastatic testicular cancers can be cured by chemotherapy followed by retroperitoneal lymph node dissection (RPLND). However, postchemotherapy RPLND confers no therapeutic benefit if the residual mass contains no viable cells. Therefore, to determine which parameters predict a patient's likelihood of having only necrosis in the residual mass, we retrospectively analyzed clinical parameters of patients who underwent postchemotherapy RPLND.
  
  
  METHODS
  Data from 27 patients with metastatic testicular cancer were analyzed. The histology of the primary tumor was seminoma in 11 cases and non-seminoma in 16 cases. All of the patients with non-seminoma showed a normalization of tumor markers after chemotherapy. Analysis of clinical parameters included data for the initial histology, pretreatment tumor marker levels, postchemotherapy retroperitoneal mass size, and the histology of the dissected RPLNs.
  
  
  RESULTS
  Histological examination of dissected RPLNs showed residual tumor in 27% of seminoma patients and 38% of non-seminoma patients. In seminoma patients, no viable cells were found in all six patients with pretreatment lactate dehydrogenase (LDH) levels below 7.5 times the upper limit of normal, or in all five of the patients with postchemotherapy RPLNs less than 2.5 cm. In non-seminoma patients, no viable cells were found in nine of 10 patients with pretreatment alpha-fetoprotein (AFP) levels less than 2700 ng/mL, or in eight of nine patients with residual mass less than 2.5 cm.
  
  
  CONCLUSIONS
  Both postchemotherapy RPLN mass size and pretreatment tumor marker levels are possible predictors for necrosis of the residual mass in testicular cancer patients.
authors.affiliation: Department of Urology, Institute of Clinical Medicine, University of Tsukuba, Tsukuba City, Japan.
authors.forename: Mizuki
authors.initials: M
authors.lastname: Onozawa
authors.forename: Koji
authors.initials: K
authors.lastname: Kawai
authors.forename: Takahiro
authors.initials: T
authors.lastname: Yamamoto
authors.forename: Shiro
authors.initials: S
authors.lastname: Hinotsu
authors.forename: Sadamu
authors.initials: S
authors.lastname: Tsukamoto
authors.forename: Kazunori
authors.initials: K
authors.lastname: Hattori
authors.forename: Naoto
authors.initials: N
authors.lastname: Miyanaga
authors.forename: Toru
authors.initials: T
authors.lastname: Shimazui
authors.forename: Hideyuki
authors.initials: H
authors.lastname: Akaza
mesh_terms: D000328:Adult; D000368:Aged; D006801:Humans; D008197:Lymph Node Excision; D008207:Lymphatic Metastasis; D008297:Male; D008875:Middle Aged; D018365:Neoplasm, Residual; D012189:Retrospective Studies; D018239:Seminoma / Q000188:drug therapy* / Q000473:pathology* / Q000556:secondary / Q000601:surgery; D013736:Testicular Neoplasms / Q000188:drug therapy* / Q000473:pathology* / Q000601:surgery