title: Outcomes of postchemotherapy retroperitoneal lymph node dissection following high-dose chemotherapy with stem cell transplantation.
abstract: BACKGROUND
  Characterizing the role of postchemotherapy retroperitoneal lymph node dissection (PC-RPLND) after high-dose chemotherapy (HDCT) has been limited by small sample sizes. This study reports on survival after HDCT with stem cell support and PC-RPLND as well as histologic findings in the retroperitoneum.
  
  
  METHODS
  The prospectively maintained testicular cancer database of Indiana University was queried for patients receiving HDCT with stem cell transplantation before PC-RPLND. The cause and date of death were obtained through patient chart review and contact with referring physicians. The Kaplan-Meier method was used to evaluate overall survival (OS). The log-rank test was used for tests of significance. A multivariate, backward, stepwise Cox regression model was built to evaluate predictors of overall mortality.
  
  
  RESULTS
  A total of 92 patients were included in the study. In the entire cohort, the retroperitoneal (RP) histology findings at the time of PC-RPLND were necrosis (26%), teratoma (34%), and cancer (38%). Sixty-six patients (72%) harbored either a teratoma or active cancer in the RP specimen at PC-RPLND. The median follow-up for the entire cohort was 80.6 months. A total of 28 patients (30%) died during follow-up. The 5-year OS rate of the entire cohort was 70%. The most significant predictor of death was PC-RPLND performed in the desperation setting with elevated markers.
  
  
  CONCLUSIONS
  Despite these patients being heavily pretreated with multiple cycles of chemotherapy, including HDCT, approximately three-fourths were found to have a teratoma and/or active cancer in the retroperitoneum. This underscores the importance of PC-RPLND for rendering patients free of disease and providing a potential for cure.
authors.affiliation: Department of Urology, Indiana University School of Medicine, Indianapolis, Indiana.
authors.forename: Clint
authors.initials: C
authors.lastname: Cary
authors.affiliation: Department of Urology, Indiana University School of Medicine, Indianapolis, Indiana.
authors.forename: Jose A
authors.initials: JA
authors.lastname: Pedrosa
authors.affiliation: Department of Urology, Indiana University School of Medicine, Indianapolis, Indiana.
authors.forename: Joseph
authors.initials: J
authors.lastname: Jacob
authors.affiliation: Department of Urology, Indiana University School of Medicine, Indianapolis, Indiana.
authors.forename: Stephen D W
authors.initials: SD
authors.lastname: Beck
authors.affiliation: Department of Urology, Indiana University School of Medicine, Indianapolis, Indiana.
authors.forename: Kevin R
authors.initials: KR
authors.lastname: Rice
authors.affiliation: Melvin and Bren Simon Cancer Center, Indiana University, Indianapolis, Indiana.
authors.forename: Lawrence H
authors.initials: LH
authors.lastname: Einhorn
authors.affiliation: Department of Urology, Indiana University School of Medicine, Indianapolis, Indiana.
authors.forename: Richard S
authors.initials: RS
authors.lastname: Foster
mesh_terms: D000328:Adult; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use*; D016208:Databases, Factual; D006801:Humans; D060828:Induction Chemotherapy; D008197:Lymph Node Excision; D008198:Lymph Nodes / Q000473:pathology*; D008297:Male; D009373:Neoplasms, Germ Cell and Embryonal / Q000473:pathology / Q000628:therapy; D012187:Retroperitoneal Space / Q000601:surgery; D016879:Salvage Therapy; D018239:Seminoma / Q000473:pathology / Q000628:therapy*; D033581:Stem Cell Transplantation; D013724:Teratoma / Q000473:pathology / Q000628:therapy*; D013736:Testicular Neoplasms / Q000473:pathology / Q000628:therapy*
keywords: germ cell tumor; high-dose chemotherapy; outcomes; retroperitoneal lymph node dissection; surgery