Introduction and Objectives
The histological finding of teratoma (T) occurs in approximately 40% of all postchemotherapy (PCT) retroperitoneal lympadenectomy (RPLA). We evaluated patients (pts) undergoing PCT-RPLA for T to determine their clinical outcome.
Material and Methods
Among a survey of 197 pts submitted to PCT-RPLA due to metastatic nonseminomatous testicular tumors (NSTT) from 1980 to 2005, we indentified 82 pts (42%) who were found to have only T in the RP. Pts undergoing ERP surgery were not included in this study because previous study have demonstrated that these pts may be at high risk of progression and relapse independent of tumor histology.
Results
Among 82 pts, 7 pts (82%) received only induction cisplatin-based CT, and 15 (18%) required additional CT regimens. PCT-RPLA pathology revealed mature T (MT) in 70 pts (86%), immature T (IMT) in 10 pts (12%) and T with malignant transformation (TMT)in 2 pts (2%). 16 pts (19%) relapsed at median free interval (MFI) of 22 months (m)(range 2–119). Among 13 pts submitted to redo-RPLA due to relapse, 7 pts (54%) had MT, 2 pts (15%) had TMT and 4 pts (31%) viable GCT (VC). 1 relapsing pt with only elevated STM achieved CR with CT alone (overall grossly 87% achieved CR in relapse). 2 pts following PCT-RPLA relapsed at 21 and 72 m with widespread metastasis and died despite salvage treatment. 7/13 pts (54%) who were rendered free of disease (ds) with redo-RPLA, relapsed again within MFI of 91 m. All but 1 pts died despite salvage treatment (2 TMT, 4 VC). Overall survival rate was 90% at median follow-up of 137 m (range 45–271). On univariate analysis, higher preand post-CT nodal size (p < 0.0005), intermediate/poor IGCCCG risk classification (p = 0.02), and the presence of TMT (p = 0.002) were significant predictors for increased risk of ds recurrence. On multivariable analysis RM size (p < 0.005), worse histology (p = 0.001) and unfavorable IGCCG risk group (p = 0.01) were predictors of ds recurrence.
Conclusions
PCT-RPLA remains critical in the management of pts with NSTT. Pts found to have T at PCT-RPLA have a probability for recurrence of 81%. The size of RM, worse histology and IGCCG risk classification were predictors of ds recurrence.
Article info
Identification
Copyright
© 2009 European Association of Urology. Published by Elsevier Inc. All rights reserved.
