title: Long-term clinical outcome after postchemotherapy retroperitoneal lymph node dissection in men with residual teratoma.
abstract: OBJECTIVE
  The histologic finding of teratoma occurs in approximately 40% of all postchemotherapy retroperitoneal lymph node dissections (PC-RPLND). We evaluated patients at our institution undergoing initial PC-RPLND for teratoma to determine their clinical outcome.
  
  
  METHODS
  We identified 210 patients from 1989 to 2003 with nonseminomatous germ cell tumors (NSGCT) who underwent initial PC-RPLND and were found to have only teratoma in the retroperitoneum. Clinical and pathologic information was obtained from our prospective surgical database, and clinical outcome was reported.
  
  
  RESULTS
  Of the 210 patients in our series, 192 (92%) received only induction chemotherapy, and 18 (9%) required additional chemotherapy regimens. PC-RPLND pathology revealed mature teratoma in 178 patients (85%), immature teratoma in 15 patients (7%), and teratoma with malignant transformation in 17 patients (8%). With a median follow-up time for survivors of 37 months, disease recurred in 30 patients. The probability of remaining free of disease recurrence at 5 and 10 years was 83% and 80%, respectively. Of the 30 patients with disease recurrence, 10 (33%) had recurrence with teratoma, five (17%) had recurrence with teratoma with malignant transformation, and 15 (50%) had recurrence with viable germ cell tumor. On multivariable analysis, residual mass size and International Germ Cell Cancer Collaborative Group (IGCCCG) risk classification were predictors of disease recurrence (P < .0005 and = .001, respectively).
  
  
  CONCLUSIONS
  PC-RPLND remains critical in the management of patients with NSGCT. Patients found to have teratoma at PC-RPLND have a 10-year probability of freedom from recurrence of 80%. The size of the residual mass and IGCCCG risk classification were significant predictors of disease recurrence.
authors.affiliation: Department of Urology and Medicine, Memorial Sloan-Kettering Cancer Center, New York, NY, USA. carverb@mskcc.org
authors.forename: Brett S
authors.initials: BS
authors.lastname: Carver
authors.forename: Bobby
authors.initials: B
authors.lastname: Shayegan
authors.forename: Angel
authors.initials: A
authors.lastname: Serio
authors.forename: Robert J
authors.initials: RJ
authors.lastname: Motzer
authors.forename: George J
authors.initials: GJ
authors.lastname: Bosl
authors.forename: Joel
authors.initials: J
authors.lastname: Sheinfeld
mesh_terms: D000970:Antineoplastic Agents / Q000627:therapeutic use*; D003131:Combined Modality Therapy; D018572:Disease-Free Survival; D005500:Follow-Up Studies; D006801:Humans; D053208:Kaplan-Meier Estimate; D008197:Lymph Node Excision; D008198:Lymph Nodes / Q000473:pathology / Q000601:surgery; D008297:Male; D009367:Neoplasm Staging; D018365:Neoplasm, Residual; D009519:New York City / Q000453:epidemiology; D011237:Predictive Value of Tests; D011379:Prognosis; D016016:Proportional Hazards Models; D012042:Registries; D012186:Retroperitoneal Neoplasms / Q000556:secondary*; D012187:Retroperitoneal Space; D018570:Risk Assessment; D013724:Teratoma / Q000188:drug therapy / Q000401:mortality / Q000556:secondary* / Q000601:surgery*; D013736:Testicular Neoplasms / Q000188:drug therapy / Q000401:mortality / Q000473:pathology / Q000601:surgery*; D013997:Time Factors; D016896:Treatment Outcome
chemical_list: D000970:Antineoplastic Agents