BJU international · 2024
Primary retroperitoneal lymph node dissection in clinical stage 2a/b non-seminomatous germ cell tumour.
СтатьяМногоцентровое исследованиеНазвание и аннотация: Перевод пока не подготовлен
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Antonelli Luca, Heidenreich Axel, Bagrodia Aditya, Amini Armon, Baky Fady, Branger Nicolas, Cazzaniga Walter, Clinton Timothy N, Daneshmand Siamak, Djaladat Hooman, Eggener Scott, Ghoreifi Alireza, Hamilton Robert J, Ho Matthew, Sexton Wade J, Nazzani Sebastiano, Nicol David, Nicolai Nicola, Olson Kathleen, Paffenholz Pia, Porter James, Qian Zhiyu, Rocco Nicholas R, Yerrapragada Anirudh, Stroup Sean P, Tachibana Isamu, Terbuch Angelika, Singla Nirmish, Cary Clint, Fankhauser Christian D, EAU‐YAU Penile and Testis Cancer Working Group
Аннотация
OBJECTIVES: To reassess the role of primary retroperitoneal lymph node dissection (RPLND) in patients with marker-negative non-seminomatous germ cell tumour (NSGCT) clinical stage (CS) 2a, to explore results in patients with CS 2b and to evaluate surgical methods, recurrence, and adjuvant chemotherapy indications.
MATERIALS AND METHODS: Data from 17 institutions were collected, comprising 305 men who underwent primary RPLND for CS 2 NSGCT. Regression analyses were conducted to predict histology in the RPLND specimen and disease-free survival (DFS).
RESULTS: A larger retroperitoneal lymph node diameter was associated with pure teratoma in the RPLND specimen (odds ratio [OR] 1.02, 95% confidence interval [CI] 1.01-1.07; P = 0.03), but no association was observed with DFS. The 5-year DFS rates in marker negative CS 2a and 2b were 79% and 76%. In men with non-teratomatous viable cancer in the RPLND specimen, the 5-year DFS rates for CS 2a and 2b were 95% and 87% with adjuvant chemotherapy, and 67% and 74% without adjuvant chemotherapy. We did not identify an association between the number of adjuvant chemotherapy cycles and DFS.
CONCLUSIONS: Our study suggests considering primary RPLND not only in marker-negative CS 2a but also in CS 2b. Further research should determine the efficacy of primary RPLND in men with CS 2c and marker-positive CS 2, as well as which patients may benefit from adjuvant chemotherapy and the optimal cycle number.
MATERIALS AND METHODS: Data from 17 institutions were collected, comprising 305 men who underwent primary RPLND for CS 2 NSGCT. Regression analyses were conducted to predict histology in the RPLND specimen and disease-free survival (DFS).
RESULTS: A larger retroperitoneal lymph node diameter was associated with pure teratoma in the RPLND specimen (odds ratio [OR] 1.02, 95% confidence interval [CI] 1.01-1.07; P = 0.03), but no association was observed with DFS. The 5-year DFS rates in marker negative CS 2a and 2b were 79% and 76%. In men with non-teratomatous viable cancer in the RPLND specimen, the 5-year DFS rates for CS 2a and 2b were 95% and 87% with adjuvant chemotherapy, and 67% and 74% without adjuvant chemotherapy. We did not identify an association between the number of adjuvant chemotherapy cycles and DFS.
CONCLUSIONS: Our study suggests considering primary RPLND not only in marker-negative CS 2a but also in CS 2b. Further research should determine the efficacy of primary RPLND in men with CS 2c and marker-positive CS 2, as well as which patients may benefit from adjuvant chemotherapy and the optimal cycle number.