title: Lymph Node Yield in Primary Retroperitoneal Lymph Node Dissection for Nonseminoma Germ Cell Tumors.
abstract: OBJECTIVE
  The number of lymph nodes removed at surgery for various malignancies has diagnostic and prognostic value. However, there are limited data on the significance of the number of nodes removed at retroperitoneal lymph node dissection performed for testicular nonseminoma germ cell tumors.
  
  
  METHODS
  From 1979 to 2012 primary open retroperitoneal lymph node dissection was performed by a single experienced surgeon for clinical stage I/II testicular nonseminoma germ cell tumor in 157 patients. Node count was available in 111 cases (71%). Factors associated with total node count and nodes with viable cancer were assessed by linear regression. The association between node count and time to relapse was assessed by multivariate Cox proportional hazards models controlled for adjuvant chemotherapy.
  
  
  RESULTS
  The median total lymph node count was 28 (IQR 19-38). Patient age, cancer laterality, body mass index, clinical stage, time from orchiectomy to retroperitoneal lymph node dissection, pathologist and lymph node dissection year were not associated with total lymph node count. A viable germ cell tumor was found in 70 patients (63%). Total node yield was not associated with nodal cancer metastasis. After lymph node dissection 17 patients (16%) received adjuvant chemotherapy. At a median 57-month followup 18 cases (17%) relapsed after primary retroperitoneal lymph node dissection. Increasing total node count was associated with a decreased risk of relapse on univariate and multivariate analysis (HR 0.96, 95% CI 0.92-0.99, p = 0.03 and HR 0.94, 95% CI 0.89-0.99, p = 0.017, respectively).
  
  
  CONCLUSIONS
  No analyzed clinical or pathological variable was associated with the node yield of primary retroperitoneal lymph node dissection. However, there may be a relationship between the total node yield at retroperitoneal lymph node dissection and the risk of relapse.
authors.affiliation: Division of Urology, Department of Surgery, University of Toronto, Toronto, Ontario, Canada.
authors.forename: Madhur
authors.initials: M
authors.lastname: Nayan
authors.affiliation: Division of Urology, Department of Surgery, University of Toronto, Toronto, Ontario, Canada.
authors.forename: Michael A S
authors.initials: MA
authors.lastname: Jewett
authors.affiliation: Department of Pathology, Princess Margaret Hospital, University Health Network, Toronto, Ontario, Canada.
authors.forename: Joan
authors.initials: J
authors.lastname: Sweet
authors.affiliation: Division of Urology, Department of Surgery, University of Toronto, Toronto, Ontario, Canada.
authors.forename: Lynn
authors.initials: L
authors.lastname: Anson-Cartwright
authors.affiliation: Department of Medicine, University of Toronto, Toronto, Ontario, Canada; Division of Medical Oncology and Hematology, Princess Margaret Cancer Centre, University Health Network, Toronto, Ontario, Canada.
authors.forename: Philippe L
authors.initials: PL
authors.lastname: Bedard
authors.affiliation: Department of Medicine, University of Toronto, Toronto, Ontario, Canada; Division of Medical Oncology and Hematology, Princess Margaret Cancer Centre, University Health Network, Toronto, Ontario, Canada.
authors.forename: Malcolm
authors.initials: M
authors.lastname: Moore
authors.affiliation: Department of Radiation Oncology, Princess Margaret Hospital, University Health Network, Toronto, Ontario, Canada.
authors.forename: Peter
authors.initials: P
authors.lastname: Chung
authors.affiliation: Department of Radiation Oncology, Princess Margaret Hospital, University Health Network, Toronto, Ontario, Canada.
authors.forename: Padraig
authors.initials: P
authors.lastname: Warde
authors.affiliation: Division of Urology, Department of Surgery, University of Toronto, Toronto, Ontario, Canada. Electronic address: rob.hamilton@uhn.ca.
authors.forename: Robert J
authors.initials: RJ
authors.lastname: Hamilton
mesh_terms: D000328:Adult; D005500:Follow-Up Studies; D006801:Humans; D008197:Lymph Node Excision / Q000379:methods*; D008198:Lymph Nodes / Q000473:pathology; D008207:Lymphatic Metastasis; D008297:Male; D009367:Neoplasm Staging; D009373:Neoplasms, Germ Cell and Embryonal / Q000175:diagnosis / Q000556:secondary* / Q000601:surgery; D011379:Prognosis; D012187:Retroperitoneal Space; D012189:Retrospective Studies; D013736:Testicular Neoplasms / Q000175:diagnosis / Q000556:secondary* / Q000601:surgery; D013997:Time Factors
keywords: lymph node excision; nonseminomatous germ cell tumor; recurrence; risk; testis