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

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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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