title: Viable malignant germ cell tumor in the postchemotherapy retroperitoneal lymph node dissection specimen: can it be predicted using clinical parameters?
abstract: BACKGROUND
  The presence of viable tumor in the surgical specimen after postchemotherapy retroperitoneal lymph node dissection (PC-RPLND) is associated with an increased risk of disease progression. The objective of this study was to determine whether the presence of viable tumor in the surgical specimen could be predicted.
  
  
  METHODS
  Between 1980 and 2003, 236 patients underwent PC-RPLND for clinical Stage IIA or III nonseminomatous germ cell tumors (NSGCT). The authors retrospectively reviewed the medical records of those patients for pertinent clinical and treatment-related outcomes. A multivariate logistic regression analysis was used to evaluate whether clinical parameters were capable of predicting the presence of viable tumor in the surgical specimen.
  
  
  RESULTS
  International Germ Cell Consensus Classification (IGCCC) risk categories could be assigned to 218 patients, with 101 patients in the good-risk category, 32 patients in the intermediate-risk category, and 85 patients in the poor-risk category. The incidence of viable tumor in the good-risk, intermediate-risk, and poor-risk categories was similar (17.8%, 15.6%, and 15.3%, respectively); however, the risk categories predicted disease-specific and recurrence-free survival (P = .022 and P < .0001, respectively). On multivariate analysis, an elevated serum alpha-fetoprotein (AFP) level prior to PC-RPLND (P = .05) and the size of the retroperitoneal mass on pathology review (P = .02) were predictive of viable tumor in the surgical specimen.
  
  
  CONCLUSIONS
  Although IGCCC risk categories were correlated with disease-related outcomes, the risk groups had similar incidences of viable tumor. Elevated serum AFP levels prior to surgery and the size of the retroperitoneal mass in the resected specimen may help to predict viable tumor in the PC-RPLND specimen.
authors.affiliation: Department of Urologic Oncology, The 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: Louis L
authors.initials: LL
authors.lastname: Pisters
authors.forename: Ping
authors.initials: P
authors.lastname: Liu
authors.forename: Shi-Ming
authors.initials: SM
authors.lastname: Tu
authors.forename: James G
authors.initials: JG
authors.lastname: Evans
authors.forename: Ashish M
authors.initials: AM
authors.lastname: Kamat
authors.forename: Peter
authors.initials: P
authors.lastname: Black
authors.forename: Nizar M
authors.initials: NM
authors.lastname: Tannir
mesh_terms: D000328:Adult; D014408:Biomarkers, Tumor / Q000097:blood; D018572:Disease-Free Survival; D006801:Humans; D008197:Lymph Node Excision; D008198:Lymph Nodes / Q000473:pathology*; D008207:Lymphatic Metastasis; D008297:Male; D008875:Middle Aged; D009373:Neoplasms, Germ Cell and Embryonal / Q000473:pathology*; D010340:Pathology, Surgical; D011379:Prognosis; D012187:Retroperitoneal Space; D012306:Risk; D013736:Testicular Neoplasms / Q000188:drug therapy* / Q000401:mortality / Q000473:pathology*; D000509:alpha-Fetoproteins / Q000032:analysis
chemical_list: D014408:Biomarkers, Tumor; D000509:alpha-Fetoproteins