title: Recurrence in nonseminomatous germ cell testis tumor patients with no viable tumor at postchemotherapy retroperitoneal lymph node dissection.
abstract: OBJECTIVE
  To determine disease-related outcomes in metastatic testis cancer patients with absence of viable cancer in the postchemotherapy retroperitoneal lymph node dissection (PC-RPLND) specimen and determine whether clinical variables can help predict disease progression.
  
  
  METHODS
  Between 1980 and 2003, 195 patients had no viable tumor at the time of PC-RPLND. We retrospectively reviewed their medical records for pertinent clinical and treatment-related outcomes. At a median follow-up of 45 months (range, 6 to 236 months), 35 patients (18%) developed recurrences, and 18 (9%) died of disease.
  
  
  RESULTS
  On multivariate analysis, predictors of recurrence-free survival in patients with no viable tumor were advanced clinical stage (P = 0.01) and poor-risk International Germ Cell Consensus Classification (IGCCC) group (P = 0.01), whereas predictors of disease-specific survival included an elevated serum beta-human chorionic gonadotropin (hCG) level before PC-RPLND (P = 0.002), pathologic diameter of the retroperitoneal mass (P = 0.05), and postoperative recurrence (P <0.0001). An hCG level greater than 1.2 mIU/mL before PC-RPLND trended toward statistical significance (P = 0.07), and pathologic diameter of the retroperitoneal mass greater than 2.5 cm was statistically significant (P = 0.05) in predicting a poorer disease-specific survival.
  
  
  CONCLUSIONS
  Patients with no viable tumor at PC-RPLND remain at risk of recurrence. Several clinical variables, including advanced clinical stage, poor-risk IGCCC group, preoperative serum hCG level, diameter of the retroperitoneal mass on pathology, and postoperative recurrence, help better define which patients are at risk.
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: Nizar M
authors.initials: NM
authors.lastname: Tannir
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: James G
authors.initials: JG
authors.lastname: Evans
authors.forename: Louis L
authors.initials: LL
authors.lastname: Pisters
mesh_terms: D000293:Adolescent; D000328:Adult; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use*; D003131:Combined Modality Therapy; D018572:Disease-Free Survival; D006801:Humans; D008197:Lymph Node Excision; D008297:Male; D008875:Middle Aged; D009373:Neoplasms, Germ Cell and Embryonal / Q000556:secondary* / Q000628:therapy*; D009919:Orchiectomy; D012187:Retroperitoneal Space; D016019:Survival Analysis; D013736:Testicular Neoplasms / Q000473:pathology / Q000628:therapy*