title: Predictors of outcome in patients undergoing postchemotherapy retroperitoneal lymph node dissection for testicular cancer.
abstract: BACKGROUND
  The management of metastatic nonseminomatous germ cell tumors (NSGCT) frequently consists of systemic chemotherapy followed by retroperitoneal lymph node dissection (PC-RPLND). The aim of the present study was to evaluate the authors' PC-RPLND experience and identify predictors of outcome in these patients.
  
  
  METHODS
  Between 1980 and 2003, 236 patients with clinical Stage IIA-III NSGCT underwent PC-RPLND. Their medical records were retrospectively reviewed for pertinent clinical and treatment-related outcomes. The 5-year disease-specific and recurrence-free survival was 85% and 75%, respectively, with the median length of follow-up after RPLND 45 months (6-250 months).
  
  
  RESULTS
  The median age of patients at diagnosis was 28 years, with all patients receiving systemic chemotherapy (median of 5 cycles) before RPLND. On multivariate analysis, predictors of poorer disease-specific survival (DSS) included systemic symptoms at presentation (P = .05), elevated pre-RPLND serum alpha fetoprotein (AFP, P = .006) and beta-human chorionic gonadotropin (HCG, P = .004), postoperative complications (P = .03), and recurrence (P < .0001). Predictors of poorer recurrence-free survival (RFS) included advanced clinical stage (IIC-III, P = .001) and presence of viable tumor in the RPLND specimen (P = .03). A pre-RPLND serum AFP > 9 ng/mL and HCG > 4.1 mIU/mL were found to predict a worse DSS (P = .03 and .03, respectively).
  
  
  CONCLUSIONS
  In patients undergoing PC-RPLND, preoperative tumor markers and the occurrence of postoperative complications or recurrence are predictive of poorer DSS. Advanced clinical stage and viable tumor in the surgical specimen predict worse RFS.
authors.affiliation: Department of Urologic Oncology, University of Texas M. D. Anderson Cancer Center, Houston, Texas, USA.
authors.forename: Philippe E
authors.initials: PE
authors.lastname: Spiess
authors.forename: Gordon A
authors.initials: GA
authors.lastname: Brown
authors.forename: Ping
authors.initials: P
authors.lastname: Liu
authors.forename: Nizar M
authors.initials: NM
authors.lastname: Tannir
authors.forename: Shi-Ming
authors.initials: SM
authors.lastname: Tu
authors.forename: James G
authors.initials: JG
authors.lastname: Evans
authors.forename: Bogdan
authors.initials: B
authors.lastname: Czerniak
authors.forename: Ashish M
authors.initials: AM
authors.lastname: Kamat
authors.forename: Louis L
authors.initials: LL
authors.lastname: Pisters
mesh_terms: D000293:Adolescent; D000328:Adult; D014408:Biomarkers, Tumor / Q000097:blood*; D003131:Combined Modality Therapy; D018572:Disease-Free Survival; D006801:Humans; D008197:Lymph Node Excision; D008297:Male; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000401:mortality*; D009367:Neoplasm Staging; D011379:Prognosis; D012187:Retroperitoneal Space; D013736:Testicular Neoplasms / Q000401:mortality* / Q000532:radiotherapy / Q000601:surgery*; D016896:Treatment Outcome
chemical_list: D014408:Biomarkers, Tumor