title: Does the histology of nodal metastasis predict systemic relapse after retroperitoneal lymph node dissection in pathological stage B1 germ cell tumors?
abstract: OBJECTIVE
  We evaluated the prognostic significance of the histology of metastatic lymph nodes to predict postoperative relapse in pathological stage B1 nonseminomatous germ cell tumor (NSGCT).
  
  
  METHODS
  A retrospective review of the testicular cancer database was performed to identify all patients with clinical stage A NSGCT who underwent primary retroperitoneal lymph node dissection and were found to have pathological stage B1 disease. No patient received adjuvant chemotherapy and minimal followup was 24 months.
  
  
  RESULTS
  A total of 118 patients were identified with a 5-year disease-free survival (DFS) of 68% and a median followup of 43 months. Embryonal cell carcinoma was identified in 92 of 118 (77%) surgical specimens, which was significantly greater than the presence of teratoma (22%), seminoma (16%) and yolk sac (14.4%, p < or = 0.001) with no difference in 5-year DFS comparing the presence or absence of each histology. Solitary histology was noted in 88 of 118 patients (74.5%). Embryonal cell carcinoma was the most common single histology identified at surgery at 64 of 88 (73%), with the incidence of seminoma, teratoma and yolk sac being 12.5%, 9.0% and 5.5%, respectively (p < or = 0.001). There was no statistical difference in DFS for each of the solitary histological subtypes (p=0.67). Recurrence rates were similar for pure embryonal cell carcinoma (69%), mixed embryonal cell carcinoma (63%) and no embryonal cell carcinoma (73%) in the retroperitoneum (p=0.63).
  
  
  CONCLUSIONS
  Retroperitoneal histology does not appear to predict outcome in patients with pathological stage B1 NSGCT.
authors.affiliation: Department od Urology, Indiana University Medical Center, Indiana Cancer Pavilion, Indianapolis, Indiana 46202, USA. stdbeck@iupui.edu
authors.forename: Stephen D W
authors.initials: SD
authors.lastname: Beck
authors.forename: Richard S
authors.initials: RS
authors.lastname: Foster
authors.forename: Richard
authors.initials: R
authors.lastname: Bihrle
authors.forename: Liang
authors.initials: L
authors.lastname: Cheng
authors.forename: John P
authors.initials: JP
authors.lastname: Donohue
mesh_terms: D018236:Carcinoma, Embryonal / Q000473:pathology; D006801:Humans; D008197:Lymph Node Excision; D008207:Lymphatic Metastasis; D008297:Male; D009364:Neoplasm Recurrence, Local / Q000473:pathology*; D009373:Neoplasms, Germ Cell and Embryonal / Q000473:pathology*; D011379:Prognosis; D012189:Retrospective Studies; D018239:Seminoma / Q000473:pathology; D013724:Teratoma / Q000473:pathology; D013736:Testicular Neoplasms / Q000473:pathology*