Clinical impact of residual extraretroperitoneal masses in patients with advanced nonseminomatous germ cell testicular cancer.
OBJECTIVE
Integration of platinum-based chemotherapy and surgical resection of residual masses is essential in the management of advanced nonseminomatous germ cell tumors (NSGCT). We reviewed our institutional experience in patients undergoing resection of extraretroperitoneal (ERP) residual masses after chemotherapy to assess its impact on cancer progression and survival.


METHODS
Between 1989 and 2003, 532 patients with advanced NSGCT underwent postchemotherapy retroperitoneal lymph node dissection (PC-RPLND) with a median follow-up of 41 months. Survival probabilities were estimated by the Kaplan-Meier method. Cox proportional hazards regression analysis was used to determine the prognostic significance of risk factors for progression and survival.


RESULTS
Of 532 patients, 402 (76%) underwent PC-RPLND alone, and 130 (24%) underwent resection of ERP residual disease concurrently or in a staged fashion within 6 weeks. Concordance between retroperitoneal (RP) and ERP sites of disease was 83% in the presence of fibrosis, 42% for teratoma, and 47% for viable NSGCT. Overall, 34% of patients undergoing resection of ERP residual disease had either teratoma or viable disease on final pathology. Five-year probability of freedom from progression was 74% (95% CI 65%, 82%) and disease-specific survival was 84% (95% CI 75%, 89%). On multivariable analysis the histologic findings at the ERP site were significant predictors of disease progression, independent of the RP findings.


CONCLUSIONS
Our data suggest that teratoma or viable NSGCT is present in approximately one-third of patients undergoing resection of residual ERP disease. The presence of residual ERP teratoma and viable NSGCT predicts for cancer progression independent of RP histology.
Department of Surgery, Urology Service, Memorial Sloan-Kettering Cancer Center, New York, NY 10021, USA.
Timothy A
TA
Masterson
Bobby
B
Shayegan
Brett S
BS
Carver
Dean F
DF
Bajorin
Darren R
DR
Feldman
Robert J
RJ
Motzer
George J
GJ
Bosl
Joel
J
Sheinfeld
D017024:Chemotherapy, Adjuvant; D015331:Cohort Studies; D018450:Disease Progression; D018572:Disease-Free Survival; D006801:Humans; D053208:Kaplan-Meier Estimate; D008197:Lymph Node Excision / Q000379:methods*; D008198:Lymph Nodes / Q000473:pathology* / Q000601:surgery; D008297:Male; D015999:Multivariate Analysis; D009361:Neoplasm Invasiveness / Q000473:pathology; D009367:Neoplasm Staging; D018365:Neoplasm, Residual / Q000401:mortality* / Q000473:pathology / Q000601:surgery*; D009373:Neoplasms, Germ Cell and Embryonal / Q000401:mortality / Q000473:pathology* / Q000628:therapy; D009919:Orchiectomy / Q000379:methods; D011379:Prognosis; D016016:Proportional Hazards Models; D012187:Retroperitoneal Space; D012189:Retrospective Studies; D018570:Risk Assessment; D016019:Survival Analysis; D013724:Teratoma / Q000401:mortality / Q000473:pathology / Q000601:surgery; D013736:Testicular Neoplasms / Q000401:mortality / Q000473:pathology* / Q000628:therapy; D016896:Treatment Outcome