Abstract
Objective
To characterize clinical and pathologic outcomes of cisplatin-refractory or relapsed
germ cell tumor (GCT) patients who underwent retroperitoneal lymph node dissection
(RPLND) following salvage chemotherapy with either conventional or high dose regimens.
Methods
Data were reviewed to identify all patients treated with TIP or TICE salvage chemotherapy
between 1994 and 2011(n = 184) at our institution. We report clinicopathologic and
outcomes data on 131 patients who were further managed with surgical resection. Using
Cox-proportional hazards models, predictors of disease-specific survival (DSS) were
analyzed.
Results
Median follow-up was 7.3 years. Of the 112 patients who underwent postsalvage chemotherapy
RPLND, histology was reported as viable GCT in 30 (27%), teratoma only in 26 (23%)
and fibrosis in 56 (50%). 5-year DSS for the entire cohort was 74% (95% confidence
interval 63%-80%). On multivariable analysis, viable GCT histology at RPLND or extra-RPLND
resection predicted for worse DSS (hazard ratio 7.37, P = .003).
Conclusions
Our data suggest that approximately half of the patient with cisplatin-refractory
or relapsed GCT salvaged with TIP or TICE chemotherapy and evidence of residual disease
are at risk of harboring either viable GCT or teratoma. This finding underlines the
critical role of surgery in the multimodality approach to the management of this advanced
disease entity. If retroperitoneal disease exists prior to salvage chemotherapy, we
recommend postchemotherapy resection in all eligible patients.
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Article info
Publication history
Published online: October 05, 2018
Footnotes
Financial Disclosure: The Sidney Kimmel Center for Prostate and Urologic Cancers, by funds provided by the Capri Foundation and T32 CA082088 from the National Cancer Institute (MIM).
Identification
Copyright
© 2018 Elsevier Inc. All rights reserved.
