Clinical Outcome of Patients with Fibrosis/Necrosis at Post-Chemotherapy Retroperitoneal Lymph Node Dissection for Advanced Germ Cell Tumors

No AccessJournal of UrologyAdult Urology1 Feb 2017Clinical Outcome of Patients with Fibrosis/Necrosis at Post-Chemotherapy Retroperitoneal Lymph Node Dissection for Advanced Germ Cell Tumors Roy Mano, Maria F. Becerra, Brett S. Carver, George J. Bosl, Robert J. Motzer, Dean F. Bajorin, Darren R. Feldman, and Joel Sheinfeld Roy ManoRoy Mano Urology Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, New York , Maria F. BecerraMaria F. Becerra Urology Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, New York , Brett S. CarverBrett S. Carver Urology Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, New York , George J. BoslGeorge J. Bosl Genitourinary Oncology Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York , Robert J. MotzerRobert J. Motzer Genitourinary Oncology Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York , Dean F. BajorinDean F. Bajorin Genitourinary Oncology Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York , Darren R. FeldmanDarren R. Feldman Genitourinary Oncology Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York , and Joel SheinfeldJoel Sheinfeld Urology Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, New York View All Author Informationhttps://doi.org/10.1016/j.juro.2016.09.113AboutFull TextPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract Purpose: Fibrosis accounts for approximately 50% of histological findings at post-chemotherapy retroperitoneal lymph node dissection, and is associated with reported relapse rates of 10% to 15%. We characterized patients with fibrosis at post-chemotherapy retroperitoneal lymph node dissection and identified predictors of adverse outcomes in this group. Materials and Methods: We reviewed the medical records of men who underwent post-chemotherapy retroperitoneal lymph node dissection between 1989 and 2013 with histological findings of necrosis/fibrosis. With few exceptions post-chemotherapy retroperitoneal lymph node dissection after 1999 was performed with a bilateral template. Clinical, pathological and treatment related data were reported. Cox regression models were built to identify predictors of disease recurrence. Results: The study cohort included 598 men with a median age of 32 years (IQR 25–38). Most cases (397 of 547, 73%) were classified as IGCCCG good risk, with no significant differences in risk classification before and after 1999 (p=0.55). Median followup was 7.3 years (IQR 3.2–12.3). The 5-year recurrence-free and overall survival rates were 94% and 96%, respectively. Overall 36 patients had disease recurrence, most of which was distant or outside the retroperitoneal lymph node dissection template. Procedures performed after 1999 and the presence of embryonal cell carcinoma on primary histology were associated with improved recurrence-free survival on multivariate analysis (p <0.01). Conclusions: Disease recurrence in patients with fibrosis at post-chemotherapy retroperitoneal lymph node dissection is an uncommon yet significant event, which is less likely to occur in patients treated after 1999 and in those with embryonal carcinoma on primary histology. References 1 : Epidemiology and diagnosis of testis cancer. Urol Clin North Am2015; 42: 269. Google Scholar 2 : The role of retroperitoneal lymph node dissection in the management of testicular cancer. Urol Oncol2004; 22: 225. 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Cancer Res1987; 47: 6810. Google Scholar © 2017 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetailsCited byRichie J (2018) Re: Surgical Management of Complex Residual Masses following Systemic Chemotherapy for Metastatic Testicular Germ Cell TumoursJournal of Urology, VOL. 200, NO. 3, (500-500), Online publication date: 1-Sep-2018. Volume 197Issue 2February 2017Page: 391-397 Advertisement Copyright & Permissions© 2017 by American Urological Association Education and Research, Inc.Keywordsfibrosislymph node excisiongerm cell and embryonalneoplasmsMetricsAuthor Information Roy Mano Urology Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, New York Equal study contribution. More articles by this author Maria F. Becerra Urology Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, New York Equal study contribution. More articles by this author Brett S. Carver Urology Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, New York More articles by this author George J. Bosl Genitourinary Oncology Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York More articles by this author Robert J. Motzer Genitourinary Oncology Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York More articles by this author Dean F. Bajorin Genitourinary Oncology Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York More articles by this author Darren R. Feldman Genitourinary Oncology Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York More articles by this author Joel Sheinfeld Urology Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, New York More articles by this author Expand All Advertisement PDF downloadLoading ...