Predictive Value of Central Sarcopenia for Perioperative and Postoperative Outcomes in Patients with Testicular Germ Cell Cancer Undergoing Post-Chemotherapy Retroperitoneal Lymph Node Dissection.

BACKGROUND

Retroperitoneal lymph node dissection (RPLND) is an effective treatment option for testicular cancer with retroperitoneal lymph node metastasis. The accurate prediction of surgical and oncological outcomes after RPLND is essential. In the present study, we aim to evaluate the effect of central sarcopenia on surgical and oncological outcomes in patients undergoing RPLND.

METHODS

This retrospective cohort study was approved by the institutional ethics committee. Patients diagnosed with metastatic testicular germ cell cancer treated with three or four cycles of bleomycin, etoposide and platinum chemotherapy followed by RPLND between 2010 and 2023 were enrolled. Demographic factors (age, gender, body mass index, comorbidities and cancer characteristics), RPLND pathology, postoperative complications and survival data were evaluated, and the relationship between the psoas lumbar vertebral index (PLVI) calculated from axial computed tomography images and clinical outcomes was examined.

RESULTS

The median follow-up duration for the 48 patients was 81.5 months (interquartile range (IQR): 32-150). The median age at RPLND was 26 years (IQR: 21-30). The median PLVI was 0.79 (IQR: 0.65-0.91), and low PLVI values were significantly associated with high postoperative complication rates (p = 0.013). Furthermore, low PLVI (p = 0.007) and large tumour size (p = 0.018) were independently associated with short metastasis-free survival (MFS).

CONCLUSIONS

Low PLVI is significantly associated with short MFS and an increased risk of postoperative complications. In addition, large tumour size predicts short MFS, and the PLVI is a potentially valuable predictive marker for surgical and oncological outcomes for patients undergoing post-chemotherapy RPLND.