title: Recurrence pattern and proposed surveillance protocol following post-chemotherapy retroperitoneal lymph node dissection.
abstract: OBJECTIVE
  We evaluated the recurrence pattern in patients with nonseminomatous germ cell tumors treated with post-chemotherapy retroperitoneal lymph node dissection and determined the optimal surveillance strategy in these patients.
  
  
  METHODS
  Between 1980 and 2003, 236 patients with clinical stage IIA-III nonseminomatous germ cell tumors underwent post-chemotherapy retroperitoneal lymph node dissection. Patients with increased preoperative tumor markers (alpha-fetoprotein greater than 15 ng/ml and/or beta-human chorionic gonadotropin greater than 2.2 U/ml) were excluded from study resulting in 198 patients for analysis. We retrospectively reviewed medical records for pertinent clinical and treatment related outcomes. In our patient population recurrence developed in 45 (23%) patients and 22 (11%) died of disease at a median followup of 41 months (range 6 to 250) after retroperitoneal lymph node dissection.
  
  
  RESULTS
  The clinical stage of testis cancer was IIA in 17, IIB in 49, IIC in 83 and III in 49 patients. Of the 45 patients with postoperative recurrence, 16 had concomitant multiple sites of recurrence with a total of 64 sites reported. Of the cases of recurrence 21 (46.7%) were in those of clinical stage III, 18 (40%) stage IIC and 6 (11.8%) stage IIB disease. The most frequent site of recurrence was the chest (32, 49%), followed by the abdomen (14, 22%), supraclavicular lymph nodes (8, 13%), brain (5, 8%) and other sites (5, 8%).
  
  
  CONCLUSIONS
  Based on the recurrence pattern we propose stage specific surveillance guidelines for the followup of patients after post-chemotherapy retroperitoneal lymph node dissection. These guidelines help identify patients at high risk for disease progression and, thus, requiring more stringent postoperative followup.
authors.affiliation: Department of Urologic Oncology, The University of Texas M. D. Anderson Cancer Center, Houston, Texas 77030, 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: Shi-Ming
authors.initials: SM
authors.lastname: Tu
authors.forename: Nizar M
authors.initials: NM
authors.lastname: Tannir
authors.forename: James G
authors.initials: JG
authors.lastname: Evans
authors.forename: Ashish M
authors.initials: AM
authors.lastname: Kamat
authors.forename: Wassim
authors.initials: W
authors.lastname: Kassouf
authors.forename: Louis L
authors.initials: LL
authors.lastname: Pisters
mesh_terms: D000293:Adolescent; D000328:Adult; D006801:Humans; D008197:Lymph Node Excision; D008297:Male; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000453:epidemiology*; D009373:Neoplasms, Germ Cell and Embryonal / Q000188:drug therapy* / Q000453:epidemiology / Q000601:surgery*; D011159:Population Surveillance; D012187:Retroperitoneal Space; D012189:Retrospective Studies; D013736:Testicular Neoplasms / Q000188:drug therapy* / Q000453:epidemiology / Q000601:surgery*