Retroperitoneal lymph node dissection with no adjuvant chemotherapy in clinical stage I nonseminomatous germ cell tumours: long-term outcome and analysis of risk factors of recurrence.
BACKGROUND
The best management for patients with clinical stage I (CS1) nonseminomatous germ cell tumours (NSGCT) is still under debate.


OBJECTIVE
We evaluated the long-term oncologic outcome of retroperitoneal lymph node dissection (RPLND) in patients with CS1 NSGCTs and reevaluated the traditional predictors of recurrence in a set of patients not undergoing adjuvant treatment.


METHODS
Between 1985 and 1995, 322 consecutive CS1 NSGCT patients underwent primary RPLND not followed by adjuvant chemotherapy in a single referral centre. Patients were followed until relapse for a median time of 17 yr.


METHODS
We estimated the crude cumulative incidence of any recurrence. Categories pN and pT, vascular invasion (VI), percentage of embryonal carcinoma, and presence of teratoma were evaluated as 2-yr recurrence predictors of event in a binary logistic model.


CONCLUSIONS
Fifty patients had a recurrence (46 in ≤ 2 yr and only 4 [1.2%] in > 2 yr). The 10-yr recurrence incidence was 15.2%. Significant predictors of recurrence at multivariable analysis were pN+, pT > 1, and the presence of VI. However, the discriminative ability of the model was modest (Harrell C = 0.74); only 9% and 3% of patients had a predicted recurrence probability > 30% and > 50%, respectively.


CONCLUSIONS
RPLND alone could prevent recurrence in 85% of patients and minimise late relapses to 1.2%. Most patients could avoid the immediate and late toxicity of chemotherapy. Prognostic parameters combined into the multivariable model appeared of limited use in identifying a subset of patients at high risk of recurrence.
Nicolai
Nicola
N
Surgery Department, Urology Unit, Fondazione IRCCS Istituto Nazionale Tumori, Milan, Italy. nicola.nicolai@istitutotumori.mi.it
Miceli
Rosalba
R
Necchi
Andrea
A
Biasoni
Davide
D
Catanzaro
Mario
M
Milani
Angelo
A
Piva
Luigi
L
Pizzocaro
Giorgio
G
Stagni
Silvia
S
Torelli
Tullio
T
Salvioni
Roberto
R
D000328:Adult; D017024:Chemotherapy, Adjuvant; D006801:Humans; D007558:Italy; D016015:Logistic Models; D008197:Lymph Node Excision; D008207:Lymphatic Metastasis; D008297:Male; D009364:Neoplasm Recurrence, Local; D009367:Neoplasm Staging; D009373:Neoplasms, Germ Cell and Embryonal / Q000556:secondary / Q000601:surgery; D009919:Orchiectomy; D018579:Patient Selection; D012187:Retroperitoneal Space / Q000601:surgery; D018570:Risk Assessment; D012307:Risk Factors; D013736:Testicular Neoplasms / Q000473:pathology / Q000601:surgery*; D013997:Time Factors; D016896:Treatment Outcome; D055815:Young Adult