Abstract
Background
To assess the clinical variables that effect progression in patients with viable tumor after post-chemotherapy lymph node dissection due to disseminated non-seminomatous germ-cell tumors.
Methods
We performed a retrospective analysis of 32 patients with viable tumor after PC-RPLND, operated between 1990 and 2016. Patients were categorized into 2 groups as favorable and non-favorable (intermedia and poor) according to International Germ Cell Consensus Classification (IGCCC). Tumor size was determined as the largest dimension of retroperitoneal mass. Clinical factors and adjuvant chemotherapy were evaluated to impact on recurrence free survival (RFS) and overall survival (OS).
Results
The median age of the patients and follow-up duration were 28.5 (17–51) years and 51.5 (4–253) months, respectively. 5-year RFS and OS were 57.8–66.8%, respectively. On univariate analysis, percentage of viable tumor, IGCCC risk group, primary site, second-line chemotherapy and surgical margin status were significant for RFS (p = 0.034, p = 0.002, p < 0.001, p = 0.011 and p < 0.001, respectively), while IGCCC risk group, second-line chemotherapy and surgical margin status were significant for OS (p = 0.004, p = 0.010 and p < 0.001, respectively). On multivariate analysis, second-line chemotherapy and surgical margin were independent risk factors for RFS (p = 0.016, HR 4.927 95% CI 1.34–18.02 and p < 0.001, OR 9.147 95% CI 2.61–31.98, respectively) and surgical margin status was the only predictor of OS (p = 0.038, HR 3.874 95% CI 1.07–13.69).
Conclusion
Retroperitoneal lymph node dissection with negative surgical margin is essential for patients with viable residual tumor after chemotherapy. Need for second-line chemotherapy shows risk of progression.
Similar content being viewed by others
References
Einhorn LH (1990) Treatment of testicular cancer: a new and improved model. J Clin Oncol 8:1777–1781
van Dijk MR, Steyerberg EW, Habbema JD (2006) Survival of non-seminomatous germ cell cancer patients according to the IGCC classification: an update based on meta-analysis. Eur J Cancer 42:820–826
Spiess PE, Brown GA, Liu P et al (2006) Predictors of outcome in patients undergoing postchemotherapy retroperitoneal lymph node dissection for testicular cancer. Cancer 107:1483–1490
Hendry WF, Norman AR, Dearnaley DP et al (2002) Metastatic nonseminomatous germ cell tumors of the testis: results of elective and salvage surgery for patients with residual retroperitoneal masses. Cancer 94:1668–1676
de Wit R, Stoter G, Kaye SB et al (1997) Importance of bleomycin in combination chemotherapy for good-prognosis testicular nonseminoma: a randomized study of the European organization for research and treatment of cancer genitourinary tract cancer cooperative group. J Clin Oncol 15:1837–1843
Albers P, Weissbach L, Krege S et al (2004) Prediction of necrosis after chemotherapy of advanced germ cell tumors: results of a prospective multicenter trial of the German testicular cancer study group. J Urol 171:1835–1838
Debono DJ, Heilman DK, Einhorn LH et al (1997) Decision analysis for avoiding postchemotherapy surgery in patients with disseminated nonseminomatous germ cell tumors. J Clin Oncol 15:1455–1464
Hartmann JT, Candelaria M, Kuczyk MA et al (1997) Comparison of histological results from the resection of residual masses at different sites after chemotherapy for metastatic non-seminomatous germ cell tumours. Eur J Cancer 33:843–847
Jacobsen NE, Foster RS, Donohue JP (2007) Retroperitoneal lymph node dissection in testicular cancer. Surg Oncol Clin N Am 16:199–220
International germ cell consensus classification: a prognostic factor-based staging system for metastatic germ cell cancers. International germ cell cancer collaborative group. J Clin Oncol 15:594–603, 1997
Motzer RJ, Amsterdam A, Prieto V et al (1998) Teratoma with malignant transformation: diverse malignant histologies arising in men with germ cell tumors. J Urol 159:133–138
Fizazi K, Tjulandin S, Salvioni R et al (2001) Viable malignant cells after primary chemotherapy for disseminated nonseminomatous germ cell tumors: prognostic factors and role of postsurgery chemotherapy–results from an international study group. J Clin Oncol 19:2647–2657
Carver BS, Serio AM, Bajorin D et al (2007) Improved clinical outcome in recent years for men with metastatic nonseminomatous germ cell tumors. J Clin Oncol 25:5603–5608
Spiess PE, Brown GA, Pisters LL et al (2006) Viable malignant germ cell tumor in the postchemotherapy retroperitoneal lymph node dissection specimen: can it be predicted using clinical parameters? Cancer 107:1503–1510
Carver BS, Sheinfeld J (2009) Management of post-chemotherapy extra-retroperitoneal residual masses. World J Urol 27:489–492
Spiess PE, Tannir NM, Tu SM et al (2007) Viable germ cell tumor at postchemotherapy retroperitoneal lymph node dissection: can we predict patients at risk of disease progression? Cancer 110:2700–2708
Fizazi K, Oldenburg J, Dunant A et al (2008) Assessing prognosis and optimizing treatment in patients with postchemotherapy viable nonseminomatous germ-cell tumors (NSGCT): results of the sCR2 international study. Ann Oncol 19:259–264
Sheinfeld J (2002) The role of adjunctive postchemotherapy surgery for nonseminomatous germ-cell tumors: current concepts and controversies. Semin Urol Oncol 20:262–271
Stephenson AJ, Bosl GJ, Motzer RJ et al (2005) Retroperitoneal lymph node dissection for nonseminomatous germ cell testicular cancer: impact of patient selection factors on outcome. J Clin Oncol 23:2781–2788
Sheinfeld J, Bajorin D (1993) Management of the postchemotherapy residual mass. Urol Clin North Am 20:133–143
Fox EP, Weathers TD, Williams SD et al (1993) Outcome analysis for patients with persistent nonteratomatous germ cell tumor in postchemotherapy retroperitoneal lymph node dissections. J Clin Oncol 11:1294–1299
Baniel J, Foster RS, Rowland RG et al (1995) Complications of post-chemotherapy retroperitoneal lymph node dissection. J Urol 153:976–980
Baniel J, Sella A (1999) Complications of retroperitoneal lymph node dissection in testicular cancer: primary and post-chemotherapy. Semin Surg Oncol 17:263–267
Acknowledgements
No financial support to declare.
Author information
Authors and Affiliations
Corresponding author
Ethics declarations
Conflicts of interest
The authors declare that there is no conflict of interest regarding the publication of this article.
Additional information
Publisher's Note
Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.
About this article
Cite this article
Altan, M., Haberal, H.B., Aşçı, A. et al. Determination of risk factors for progression in patients with viable tumor at post-chemotherapy lymph node dissection due to disseminated non-seminomatous germ-cell tumors. Int J Clin Oncol 26, 186–191 (2021). https://doi.org/10.1007/s10147-020-01786-8
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s10147-020-01786-8