Introduction and Objectives
We reviewed our experience with retroperitoneal lymphadenectomy (RPLA) after multiple cisplatin (CDDP)-based chemotherapy (CT) regimens in nonseminomatous testicular tumors (NSTT) patients (pts) and specifically evaluated clinic-pathologic and treatment trend in addition to potential predictors of survival.
Material and Methods
41 pts with NSTT underwent their RPLA between 1980 and 2005 after >2 regimens of CT. 13 pts (32%) necessitate redo-RPLA, combined with nephrectomy in pts. 13 extra-RP resections were performed in 11 pts (27%), including pulmonary (7), neck (4) and liver (2) sites.
Results
30 pts (73%) are rendered grossly free of disease (ds) and 26 (63%) obtained serologic remission. 9 pts who relapsed within MFI of 28 months (m) (RPLN 8, RPLN+lung 1) necessitated CT+surgery (3 teratoma, 6 vital GCT). 4/9 relapsing pts (44%) are currently free of ds with redo-RPLA. Alive, free of ds are 19 pts (46%) at MFU of 131 m. Study of RP pathology demonstrated the presence of fibrosis in 15%, teratoma in 39% and vital GCT in 46%, with survival in 67%, 56%, and 32%, respectively. Worse vs favourable histology occurred in relation of 32% vs 59% (p < 0.05). Different histology occurred in 38% at redo-RPLA and in 64% at ERP resection in comparison to previous RP pathology (p = 0.219). Univariate analysis of clinico-pathologic parameters associated with vital GCT at RPLA included RP mass >5 cm (p< 0.05), elevated AFP (p < 0.001) or HCG (p < 0.05) and ERP resection (p < 0.04). On univariate analysis survival was worse in pts with RP masses >5 cm (p< 0.04), elevated AFP (p < 0.05) or HCG (p < 0.007), ERP resection (p < 0.01), and vital GCT (p < 0.004). On multivariable analysis, a RP mass >5 cm (p< 0.03) and vital GCT (p < 0.005) predicted a worse prognosis. Vital GCT either in the RP or in ERP sites predicted worse prognosis (p = 0.001).
Conclusions
Our data support the continued use of salvage RPLA in 3 separated groups of pts: 1. Pts who achieved a CR on 2nd line CT and have no radiologic evidence of ds should undergo RPLA; 2. Pts who achieved a PR to CT should undergo RPLA with ERP surgery, as indicated; 3. Highly selected pts with residual mass and elevated STM, particularly AFP, after CT may be candidates for surgery.
Article info
Identification
Copyright
© 2009 European Association of Urology. Published by Elsevier Inc. All rights reserved.
