title: Trends of retroperitoneal lymphadenectomy use in patients with nonseminomatous germ cell tumor of the testis: a population-based study.
abstract: BACKGROUND
  Retroperitoneal lymphadenectomy (RPLND), chemotherapy, and active surveillance represent treatment options for patients with nonseminomatous germ-cell tumors of the testis (NSGCTT). Our objective was to assess the utilization rate of RPLND in patients with NSGCTT.
  
  
  METHODS
  Within the Surveillance, Epidemiology and End Results (SEER) cohort, 4,620 and 1,671 patients with stage I and II NSGCTT were diagnosed between the years 1988 and 2006. Univariable and multivariable logistic regression analyses were performed to test the predictors of RPLND use in respectively patients with stage I and II NSGCTT.
  
  
  RESULTS
  The rate of RPLND according to stage I and II was 27 and 58%, respectively. In patients with stage I disease, the rate of RPLND decreased from 39% in 1988-1995 to 18% in 2004-2006 (P < 0.001), and remained stable for stage II patients (62-56%, P = 0.2). Regional variability existed regarding the rate of RPLND use only in stage I (Utah: 51% vs. Louisiana: 16%). Multivariable analyses performed in stage I NSGCTT revealed that year of diagnosis, SEER registry, and age were significant predictors of RPLND use. However, none of these variables achieved statistical significance within stage II NSGCTT patients.
  
  
  CONCLUSIONS
  In patients with stage I NSGCCT, the RPLND utilization rate decreased during the study span. This observation may be ascribed to wider use of surveillance or chemotherapy. No temporal difference was recorded in patients with stage II NSGCCT.
authors.affiliation: Cancer Prognostics and Health Outcomes Unit, University of Montreal Health Center (CHUM), Montreal, QC, Canada. mcw.sun@umontreal.ca
authors.forename: Maxine
authors.initials: M
authors.lastname: Sun
authors.forename: Firas
authors.initials: F
authors.lastname: Abdollah
authors.forename: Lars
authors.initials: L
authors.lastname: Budaüs
authors.forename: Daniel
authors.initials: D
authors.lastname: Liberman
authors.forename: Zhe
authors.initials: Z
authors.lastname: Tian
authors.forename: Monica
authors.initials: M
authors.lastname: Morgan
authors.forename: Rupinder
authors.initials: R
authors.lastname: Johal
authors.forename: Jan
authors.initials: J
authors.lastname: Schmitges
authors.forename: Shahrokh F
authors.initials: SF
authors.lastname: Shariat
authors.forename: Francesco
authors.initials: F
authors.lastname: Montorsi
authors.forename: Markus
authors.initials: M
authors.lastname: Greafen
authors.forename: Paul
authors.initials: P
authors.lastname: Perrotte
authors.forename: Pierre I
authors.initials: PI
authors.lastname: Karakiewicz
mesh_terms: D000328:Adult; D015331:Cohort Studies; D005500:Follow-Up Studies; D006801:Humans; D008197:Lymph Node Excision / Q000706:statistics & numerical data*; D008207:Lymphatic Metastasis; D008297:Male; D009026:Mortality / Q000639:trends*; D009367:Neoplasm Staging; D009373:Neoplasms, Germ Cell and Embryonal / Q000453:epidemiology* / Q000401:mortality / Q000601:surgery*; D011183:Postoperative Complications; D011379:Prognosis; D012187:Retroperitoneal Space / Q000601:surgery*; D018426:SEER Program; D015996:Survival Rate; D013736:Testicular Neoplasms / Q000453:epidemiology* / Q000401:mortality / Q000601:surgery*; D014481:United States / Q000453:epidemiology