Retroperitoneal lymph node dissection with no adjuvant chemotherapy in clinical stage i nonseminomatous germ cell tumours: Long-term outcome and analysis of risk factors of recurrence

Nicola Nicolai, Rosalba Miceli, Andrea Necchi, Davide Biasoni, Mario Catanzaro, Angelo Milani, Luigi Piva, Giorgio Pizzocaro, Silvia Stagni, Tullio Torelli, Roberto Salvioni

Research output: Contribution to journalArticlepeer-review

Abstract

Background: The best management for patients with clinical stage I (CS1) nonseminomatous germ cell tumours (NSGCT) is still under debate. Objective: We evaluated the long-term oncologic outcome of retroperitoneal lymph node dissection (RPLND) in patients with CS1 NSGCTs and reevaluated the traditional predictors of recurrence in a set of patients not undergoing adjuvant treatment. Design, setting, and participants: Between 1985 and 1995, 322 consecutive CS1 NSGCT patients underwent primary RPLND not followed by adjuvant chemotherapy in a single referral centre. Patients were followed until relapse for a median time of 17 yr. Measurements: We estimated the crude cumulative incidence of any recurrence. Categories pN and pT, vascular invasion (VI), percentage of embryonal carcinoma, and presence of teratoma were evaluated as 2-yr recurrence predictors of event in a binary logistic model. Results and limitations: Fifty patients had a recurrence (46 in ≤2 yr and only 4 [1.2%] in >2 yr). The 10-yr recurrence incidence was 15.2%. Significant predictors of recurrence at multivariable analysis were pN+, pT >1, and the presence of VI. However, the discriminative ability of the model was modest (Harrell C = 0.74); only 9% and 3% of patients had a predicted recurrence probability >30% and >50%, respectively. Conclusions: RPLND alone could prevent recurrence in 85% of patients and minimise late relapses to 1.2%. Most patients could avoid the immediate and late toxicity of chemotherapy. Prognostic parameters combined into the multivariable model appeared of limited use in identifying a subset of patients at high risk of recurrence.

Original languageEnglish
Pages (from-to)912-918
Number of pages7
JournalEuropean Urology
Volume58
Issue number6
DOIs
Publication statusPublished - Dec 2010

Keywords

  • Clinical stage I
  • Germ cell and embryonal
  • Lymph node excision
  • Neoplasms
  • Retroperitoneal space
  • Risk factors

ASJC Scopus subject areas

  • Urology

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