Objective
To evaluate, in detail, the histopathologic features of metastatic testicular germ
cell tumors to retroperitoneal lymph nodes treated with primary retroperitoneal lymph
node dissection (RPLND) and correlate the findings with patients' outcomes.
Materials and Methods
We studied 183 patients with documented pathologic stage II disease with or without
elevated serum tumor markers, selected from 453 patients who underwent primary RPLND
at our institution from 1989 to 2002. Tumor type(s), size and extent of disease, and
amount of tumor necrosis were assessed and correlated with outcome.
Results
Embryonal carcinoma was the most common tumor type, present as the only component
in 99 cases (54%) and the predominant tumor type (>50%) in 142 (78%). The number of
positive lymph nodes ranged from 1 to 40 from a total of 2-80 lymph nodes examined
(median, 28). Extranodal extension (ENE) was identified in 120 cases (66%). Among
73 patients followed up expectantly and with normal serum tumor markers, 19 experienced
relapse, the probability of which was higher in patients with more positive nodes,
larger metastases, and presence of ENE. However, none of these differences was statistically
significant (all P >.2). The predominance of embryonal carcinoma and the presence of tumor necrosis
were not significantly associated with outcome.
Conclusion
In this cohort, most patients treated with primary RPLND and with positive lymph nodes
also had ENE. We did not identify any variables to be significantly associated with
relapse after RPLND in patients managed expectantly. Additional studies with more
patients are needed to validate our findings.
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References
- Testicular germ-cell cancer.N Engl J Med. 1997; 337: 242-253
- The role of retroperitoneal lymph node dissection in the management of testicular cancer.Urol Oncol. 2004; 22: 225-233
- The pathology of late recurrence of testicular germ cell tumors.Am J Surg Pathol. 2000; 24: 257-273
- Low-volume nodal metastases detected at retroperitoneal lymphadenectomy for testicular cancer: pattern and prognostic factors for relapse.J Clin Oncol. 2001; 19: 2020-2025
- Relapse-free and overall survival in patients with pathologic stage II nonseminomatous germ cell cancer treated with etoposide and cisplatin adjuvant chemotherapy.J Clin Oncol. 2004; 22: 464-467
- Etoposide and cisplatin adjuvant therapy for patients with pathologic stage II germ cell tumors.J Clin Oncol. 1995; 13: 2700-2704
- Immediate adjuvant chemotherapy versus observation with treatment at relapse in pathological stage II testicular cancer.N Engl J Med. 1987; 317: 1433-1438
- Histopathology in the prediction of relapse of patients with stage I testicular teratoma treated by orchidectomy alone.Lancet. 1987; 2: 294-298
- Orchiectomy alone in clinical stage I nonseminomatous testis cancer: a critical appraisal.J Clin Oncol. 1986; 4: 35-40
- Prognostic factors in clinical stage I non-seminomatous germ-cell tumours of the testis.Br J Cancer. 1982; 45: 167-173
- Clinical stage I testis cancer: long-term outcome of patients on surveillance.J Urol. 1998; 159: 855-858
- Retroperitoneal lymph node dissection for nonseminomatous germ cell testicular cancer: impact of patient selection factors on outcome.J Clin Oncol. 2005; 23: 2781-2788
- American Joint Committee on Cancer (AJCC) Cancer Staging Manual.Springer-Verlag, New York2002 (301-46)
- TNM: evolution and relation to other prognostic factors.Semin Surg Oncol. 2003; 21: 3-7
- Dissemination and growth of cancer cells in metastatic sites.Nat Rev Cancer. 2002; 2: 563-572
- The significance of extracapsular extension of axillary lymph node metastases in early-stage breast cancer.Int J Radiat Oncol Biol Phys. 2000; 46: 31-34
- Identification of extracapsular invasion of the metastatic lymph nodes as a useful prognostic sign in patients with resectable colorectal cancer.Dis Colon Rectum. 2001; 44: 1838-1844
- Significance of axillary lymph node extranodal soft tissue extension and indications for postmastectomy irradiation.Cancer. 1999; 86: 1258-1262
- The management of patients with nonseminomatous germ cell tumors of the testis with serologic disease only after orchiectomy.J Urol. 1994; 152: 111-113
- The management of patients with clinical stage I nonseminomatous testicular tumors and persistently elevated serologic markers.J Urol. 1996; 155: 587-589
- Impact of the number of positive lymph nodes on disease-free survival in patients with pathological stage B1 nonseminomatous germ cell tumor.J Urol. 2005; 174: 143-145
- Lymph node-based prognostics: limitations with individualized cancer treatment.Am J Clin Oncol. 2006; 29: 298-304
- Stage II nonseminomatous germ cell tumors of the testis: an analysis of treatment options in patients with low volume retroperitoneal disease.J Urol. 1988; 140: 1437-1441
- Is adjuvant chemotherapy necessary for patients with stage B1 testicular cancer?.J Clin Oncol. 1991; 9: 1393-1396
- Surgical treatment of patients with stages I and II nonseminomatous testicular cancer.J Urol. 1985; 134: 70-73
- Stage II nonseminomatous testicular cancer: a 10-year experience.J Clin Oncol. 1983; 1: 171-178
- No adjuvant chemotherapy in selected patients with pathologic stage II nonseminomatous germ cell tumors of the testis.J Urol. 1984; 131: 677-680
- Adjuvant chemotherapy combination of vinblastine, actinomycin D, Bleomycin, and Chlorambucil following retroperitoneal lymph node dissection for stage II testis tumor.Cancer. 1981; 47: 840-844
- Does the histology of nodal metastasis predict systemic relapse after retroperitoneal lymph node dissection in pathological stage B1 germ cell tumors?.J Urol. 2005; 174: 1287-1290
Article info
Publication history
Published online: October 03, 2013
Accepted:
April 27,
2013
Received:
December 28,
2012
Footnotes
Financial Disclosure: The authors declare that they have no relevant financial interests.
Identification
Copyright
© 2013 Elsevier Inc. Published by Elsevier Inc. All rights reserved.
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- Editorial CommentUrologyVol. 82Issue 6
- PreviewThe authors examine the clinical and pathologic characteristics of 73 patients undergoing primary retroperitoneal lymph node dissection (RPLND) with pathologic stage II disease who did not receive adjuvant chemotherapy. Of these patients who had normal serum tumor markers after RPLND, 19 of 73 (26%) had relapse of disease. Although they found that more positive nodes, larger metastases, and presence of extranodal extension increased the likelihood of recurrence, none of these factors was statistically significant.
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