No announcement yet.

Long-Term Clinical Outcome After Postchemo RPLND in Men with Residual Teratoma

  • Filter
  • Time
  • Show
Clear All
new posts

  • Long-Term Clinical Outcome After Postchemo RPLND in Men with Residual Teratoma

    JCO Early Release, published online ahead of print Jan 29 2007
    Journal of Clinical Oncology, 10.1200/JCO.2005.05.4791

    Long-Term Clinical Outcome After Postchemotherapy Retroperitoneal Lymph Node Dissection in Men With Residual Teratoma
    Brett S. Carver,* Bobby Shayegan, Angel Serio, Robert J. Motzer, George J. Bosl, and Joel Sheinfeld From the Department of Urology and Medicine, Memorial Sloan-Kettering Cancer Center, New York, NY.

    Purpose: The histologic finding of teratoma occurs in approximately 40% of all postchemotherapy retroperitoneal lymph node dissections (PC-RPLND). We evaluated patients at our institution undergoing initial PC-RPLND for teratoma to determine their clinical outcome.

    Patients and Methods: We identified 210 patients from 1989 to 2003 with nonseminomatous germ cell tumors (NSGCT) who underwent initial PC-RPLND and were found to have only teratoma in the retroperitoneum. Clinical and pathologic information was obtained from our prospective surgical database, and clinical outcome was reported.

    Results: Of the 210 patients in our series, 192 (92%) received only induction chemotherapy, and 18 (9%) required additional chemotherapy regimens. PC-RPLND pathology revealed mature teratoma in 178 patients (85%), immature teratoma in 15 patients (7%), and teratoma with malignant transformation in 17 patients (8%). With a median follow-up time for survivors of 37 months, disease recurred in 30 patients. The probability of remaining free of disease recurrence at 5 and 10 years was 83% and 80%, respectively. Of the 30 patients with disease recurrence, 10 (33%) had recurrence with teratoma, five (17%) had recurrence with teratoma with malignant transformation, and 15 (50%) had recurrence with viable germ cell tumor. On multivariable analysis, residual mass size and International Germ Cell Cancer Collaborative Group (IGCCCG) risk classification were predictors of disease recurrence (P < .0005 and = .001, respectively).

    Conclusion: PC-RPLND remains critical in the management of patients with NSGCT. Patients found to have teratoma at PC-RPLND have a 10-year probability of freedom from recurrence of 80%. The size of the residual mass and IGCCCG risk classification were significant predictors of disease recurrence.
    Retired moderator. Husband, left I/O 16Dec2005, stage I seminoma with elevated b-HCG, no LVI, RTx15 (25Gy). All clear ever since.