title: Presence of teratoma in orchiectomy specimen increases the need for postchemotherapy RPLND.
abstract: OBJECTIVE
  This study was carried out to evaluate the impact of the presence of teratomatous component in orchiectomy specimen on complete response rates to primary chemotherapy in a large series of patients with stage II nonseminomatous germ cell tumors (NSGCT).
  
  
  METHODS
  Chemotherapy was administered to 113 patients with stage II testicular NSGCT. Resection of retroperitoneal residual tumor masses was performed in all patients with partial response to chemotherapy. Patients were categorized into 2 groups according to presence or absence of teratomatous component in the primary orchiectomy specimen.
  
  
  RESULTS
  Of patients with teratomatous component in the orchiectomy specimen, 32.1% (17/53) had complete response to primary chemotherapy and of those without teratomatous component 55% (33/60) had complete response (P = 0.022). Stage IIC patients had lower response rate 28.8% (23/80) compared with IIA and IIB patients (P = 0.0001). Teratomatous elements were found in retroperitoneal mass in 70.6% of patients with teratomatous component in orchiectomy specimens compared to 36.8% of patients without teratomatous component (P = 0.022). After retroperitoneal surgery and additional treatments, complete response rate increased to 92.4% and 89.5% in patients with and without teratomatous component in primary pathology, respectively, (P > 0.05).
  
  
  CONCLUSIONS
  Since teratomatous component in orchiectomy specimen is a predictor of teratoma in the residual retroperitoneal mass, it decreases the response rate to primary chemotherapy and increases the need for postchemotherapy retroperitoneal lymph node dissection (RPLND) in metastatic NSGCT patients.
authors.affiliation: Department of Urology, Hacettepe University, Faculty of Medicine, Ankara, Turkey. kuinci@hacettepe.edu.tr
authors.forename: Kubilay
authors.initials: K
authors.lastname: Inci
authors.forename: Hasan Serkan
authors.initials: HS
authors.lastname: Dogan
authors.forename: Bulent
authors.initials: B
authors.lastname: Akdogan
authors.forename: Dilek Ertoy
authors.initials: DE
authors.lastname: Baydar
authors.forename: Ali
authors.initials: A
authors.lastname: Ergen
authors.forename: Haluk
authors.initials: H
authors.lastname: Ozen
mesh_terms: D000293:Adolescent; D000328:Adult; D000970:Antineoplastic Agents / Q000627:therapeutic use; D005500:Follow-Up Studies; D006801:Humans; D008197:Lymph Node Excision; D008207:Lymphatic Metastasis; D008297:Male; D008875:Middle Aged; D009367:Neoplasm Staging; D009919:Orchiectomy; D012187:Retroperitoneal Space; D015996:Survival Rate; D013724:Teratoma / Q000175:diagnosis* / Q000188:drug therapy*; D013736:Testicular Neoplasms / Q000175:diagnosis* / Q000188:drug therapy*; D016896:Treatment Outcome; D055815:Young Adult
chemical_list: D000970:Antineoplastic Agents