title: Clinical Outcome of Patients with Fibrosis/Necrosis at Post-Chemotherapy Retroperitoneal Lymph Node Dissection for Advanced Germ Cell Tumors.
abstract: Fibrosis accounts for approximately 50% of histological findings at post-chemotherapy retroperitoneal lymph node dissection, and is associated with reported relapse rates of 10% to 15%. We characterized patients with fibrosis at post-chemotherapy retroperitoneal lymph node dissection and identified predictors of adverse outcomes in this group.
  
  
  
  We reviewed the medical records of men who underwent post-chemotherapy retroperitoneal lymph node dissection between 1989 and 2013 with histological findings of necrosis/fibrosis. With few exceptions post-chemotherapy retroperitoneal lymph node dissection after 1999 was performed with a bilateral template. Clinical, pathological and treatment related data were reported. Cox regression models were built to identify predictors of disease recurrence.
  
  
  
  The study cohort included 598 men with a median age of 32 years (IQR 25-38). Most cases (397 of 547, 73%) were classified as IGCCCG good risk, with no significant differences in risk classification before and after 1999 (p=0.55). Median followup was 7.3 years (IQR 3.2-12.3). The 5-year recurrence-free and overall survival rates were 94% and 96%, respectively. Overall 36 patients had disease recurrence, most of which was distant or outside the retroperitoneal lymph node dissection template. Procedures performed after 1999 and the presence of embryonal cell carcinoma on primary histology were associated with improved recurrence-free survival on multivariate analysis (p <0.01).
  
  
  
  Disease recurrence in patients with fibrosis at post-chemotherapy retroperitoneal lymph node dissection is an uncommon yet significant event, which is less likely to occur in patients treated after 1999 and in those with embryonal carcinoma on primary histology.
authors.affiliation: Urology Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, New York.
authors.forename: Roy
authors.initials: R
authors.lastname: Mano
authors.affiliation: Urology Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, New York.
authors.forename: Maria F
authors.initials: MF
authors.lastname: Becerra
authors.affiliation: Urology Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, New York.
authors.forename: Brett S
authors.initials: BS
authors.lastname: Carver
authors.affiliation: Genitourinary Oncology Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York.
authors.forename: George J
authors.initials: GJ
authors.lastname: Bosl
authors.affiliation: Genitourinary Oncology Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York.
authors.forename: Robert J
authors.initials: RJ
authors.lastname: Motzer
authors.affiliation: Genitourinary Oncology Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York.
authors.forename: Dean F
authors.initials: DF
authors.lastname: Bajorin
authors.affiliation: Genitourinary Oncology Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York.
authors.forename: Darren R
authors.initials: DR
authors.lastname: Feldman
authors.affiliation: Urology Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, New York. Electronic address: sheinfej@mskcc.org.
authors.forename: Joel
authors.initials: J
authors.lastname: Sheinfeld
mesh_terms: D000328:Adult; D000970:Antineoplastic Agents / Q000627:therapeutic use; D005355:Fibrosis / Q000473:pathology*; D006801:Humans; D008197:Lymph Node Excision / Q000379:methods*; D008198:Lymph Nodes / Q000473:pathology / Q000601:surgery; D008207:Lymphatic Metastasis; D008297:Male; D009336:Necrosis / Q000473:pathology*; D009364:Neoplasm Recurrence, Local / Q000453:epidemiology / Q000473:pathology; D009373:Neoplasms, Germ Cell and Embryonal / Q000188:drug therapy / Q000473:pathology* / Q000601:surgery; D012187:Retroperitoneal Space / Q000473:pathology*; D012189:Retrospective Studies; D015996:Survival Rate; D013736:Testicular Neoplasms / Q000188:drug therapy / Q000473:pathology* / Q000601:surgery; D013737:Testis / Q000473:pathology / Q000601:surgery; D016896:Treatment Outcome
chemical_list: D000970:Antineoplastic Agents
keywords: fibrosis; germ cell and embryonal; lymph node excision; neoplasms