title: Does the presence of extranodal extension in pathological stage B1 nonseminomatous germ cell tumor necessitate adjuvant chemotherapy?
abstract: OBJECTIVE
  The presence of extranodal extension identified at primary retroperitoneal lymph node dissection has been associated with an increased risk of disease recurrence, and as such these patients are sometimes treated with adjuvant chemotherapy. We decided to evaluate the significance of extranodal extension on disease-free survival in patients with pathological stage B nonseminomatous germ cell tumor who did not receive adjuvant chemotherapy.
  
  
  METHODS
  A retrospective review of our testicular cancer database was performed to identify all patients with clinical stage A nonseminomatous germ cell tumor who underwent primary retroperitoneal lymph node dissection and were found to have retroperitoneal metastasis with 5 or fewer involved nodes and no metastatic node larger than 2 cm. No patient received adjuvant chemotherapy, and all had a minimum followup of 24 months. A single pathologist (LC), who was blinded to clinical outcome, reviewed the retroperitoneal nodal package to identify the presence or absence of extranodal extension, defined as cancer perforating through the lymph node capsule into perinodal tissue.
  
  
  RESULTS
  A total of 80 patients were identified with a median followup 48 months, and a 2 and 5-year disease-free survival of 75%. Extranodal extension was present in 23 patients and absent in 57 patients with a median followup of 54 and 44 months, respectively. The 5-year disease-free survival for patients with and without extranodal extension was 74% and 75%, respectively (p=0.67).
  
  
  CONCLUSIONS
  We were unable to detect any prognostic significance of extranodal extension in patients found to have retroperitoneal metastasis at primary retroperitoneal lymph node dissection.
authors.affiliation: Department of Urology, Indiana University, Indianapolis, Indiana 46202, USA. stdbeck@iupui.edu
authors.forename: Stephen D W
authors.initials: SD
authors.lastname: Beck
authors.forename: Liang
authors.initials: L
authors.lastname: Cheng
authors.forename: Richard
authors.initials: R
authors.lastname: Bihrle
authors.forename: John P
authors.initials: JP
authors.lastname: Donohue
authors.forename: Richard S
authors.initials: RS
authors.lastname: Foster
mesh_terms: D000328:Adult; D015331:Cohort Studies; D018572:Disease-Free Survival; D006801:Humans; D008197:Lymph Node Excision; D008198:Lymph Nodes / Q000473:pathology*; D008297:Male; D009373:Neoplasms, Germ Cell and Embryonal / Q000556:secondary* / Q000601:surgery; D009919:Orchiectomy; D011237:Predictive Value of Tests; D012187:Retroperitoneal Space; D012189:Retrospective Studies; D013736:Testicular Neoplasms / Q000473:pathology* / Q000601:surgery; D016896:Treatment Outcome