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565 QUANTITATIVE ANALYSIS OF LYMPH NODE NUMBER RESECTED AT PRIMARY RETROPERITONEAL LYMPH NODE DISSECTION (RPLND)
Vol. 183, No. 4, Supplement, Sunday, May 30, 2010
cancer are reported. Categorical variables were compared using the chi-square or Fisher’s exact test. Logistic regression was used to assess factors that were associated with the presence of viable cancer. Survival analysis was performed using the Kaplan-Meier method, and comparisons were made using the log-rank test. RESULTS: Viable cancer was more prevalent in patients with increasing clinical stage, IGCCCG risk category, pre-chemotherapy mass size, pre-surgery mass size, elevated AFP, elevated HCG, and patients that received 2nd/3rd line vs. induction chemotherapy. Actuarial 5-year relapse free survival (RFS) was 62% (95% CI 49, 72). RFS was not significantly different between patients that received induction chemotherapy vs. 2nd/3rd line chemotherapy. Adjuvant chemotherapy significantly improved RFS rates in patients that received induction chemotherapy, but not in patients that received 2nd/3rd line chemotherapy prior to PC-RPLND. Actuarial 5-year disease specific survival (DSS) was 71% ( 95%CI 58,80). Disease specific survival was significantly worse in patients that received 2nd/3rd line chemotherapy (p⫽0.05). CONCLUSIONS: Following chemotherapy a significant number of patients with viable cancer are cured after surgery even in the setting of salvage chemotherapy. Surgery remains an integral component in the multidisciplinary treatment of patients with advanced GCTs. Cure can be achieved in 78% of patients after induction chemo and 58% of patients after salvage chemotherapy at 5 years. Source of Funding: None
563 OUTCOMES IN PATIENTS UNDERGOING POST-CHEMOTHERAPY RETROPERITONEAL LYMPH NODE DISSECTION FOR BULKY RETROPERITONEAL MASSES Eric Reid, Craig Nichols, Siamak Daneshmand*, Portland, OR INTRODUCTION AND OBJECTIVES: Up to 50% of patients who undergo induction chemotherapy for metastatic germ cell cancer have significant residual retroperitoneal disease requiring resection for complete cure. The goal of this study was to evaluate clinical outcomes for patients undergoing post-chemo retroperitoneal lymph node dissection (PC-RPLND) for bulky retroperitoneal masses. METHODS: We performed a retrospective analysis of all patients at our institution that underwent a PC-RPLND from October 2004 to October 2009. We reviewed their hospital course, pathology, preoperative imaging, and follow up data. Patients were separated into three groups based on the size of the residual retroperitoneal mass: Group 1, less than 5 cm in size, group 2, 5-10 cm in size, and group 3, greater than 10 cm in size. Bulky retroperitoneal masses were defined as those greater than 5 cm in size. Clinical outcomes were also analyzed for three separate time periods: Perioperative, early post-operative (⬍30 days) and late post-operative (⬎30 days). RESULTS: We identified 58 patients who met study criteria. A total of 60 operations were performed on these patients. Twenty-five patients had residual masses less than 5 cm in size, 24 patients had masses 5-10 cm in size, and 9 patients had a mass greater than 10 cm. Pathology on group 1 patients revealed 16% with residual cancer, 36% with teratoma, and 48% with fibrosis. These percentages changed for group 2 with 21% residual disease, 43% teratoma, and 36% fibrosis. One patient in group 3 (11%) had fibrosis while the 8 other patients had residual teratoma. Median blood loss was higher in groups 2 and 3 (1325 ml and 1050 ml versus 500 ml in group 1). The number of patients undergoing adjuvant procedures was also higher in groups 2 and 3 compared with group 1 (54% and 40% versus 24%). The percentages of early complications were 16%, 33%, and 40% in groups 1,2, and 3 respectively. Late complications were also slightly higher in groups 2(17%) and 3 (10%) than in group 1 (8%). No significant differences in the percentage of patients with disease recurrence were noted among groups 1,2, and 3(12%, 21% and 11%, respectively). CONCLUSIONS: Patients with bulky masses have slightly higher perioperative morbidity but no significant change in rate of
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disease recurrence. Masses greater than 10 cm are likely to be teratomas. Resection of bulky retroperitoneal masses warrants addition preoperative planning, but can be curative in the majority of cases. Source of Funding: None
564 PRIMARY VERSUS POST-CHEMOTHERAPY RETROPERITONEAL LYMPH NODE DISSECTION (RPLND) IN PATIENTS WITH PRESENCE OF TERATOMA AT ORCHIECTOMY Stephen Williams*, Belmont, MA; Ravi Kacker, Graeme Steele, Jerome Richie, Boston, MA INTRODUCTION AND OBJECTIVES: The presence of teratoma in the primary orchiectomy specimen creates controversies for subsequent management. Although teratoma predominant is less likely to metastasize, teratoma in the retroperitoneum may be less amenable to chemotherapy. In order to elucidate the issues about teratoma in the primary tumor, we reviewed differences between primary retroperitoneal lymph node dissection (P-RPLND) versus post-chemotherapy RPLND (PC-RPLND) in patients with teratoma at orchiectomy. METHODS: Patients who had undergone RPLND at our institution from 2001 to 2008 were identified and clinical charts reviewed. 83 patients with teratoma at orchiectomy were identified and peri-operative data was obtained. RESULTS: Of the 83 patients with teratoma at orchiectomy who underwent RPLND, 44 (53%) and 39 (47%) underwent primary and PC-RPLND, respectively. Median follow-up was 1.4 years. In addition to teratoma in the primary tumory, 37 (45%) patients had embryonal carcinoma and 32 (39%) had lymphovascular invasion (LVI). There were 19 (43%) positive lymph nodes for P-RPLND of which 13 (68.4%) contained teratoma. For the PC-RPLND group, 30 (77%) of lymph nodes were positive of which 28 (93.3%) contained teratoma. There were 3 (4%) recurrences overall, all of which recurred in the PCRPLND group. There were 11 (13%) perioperative complications total. There were no deaths in either group. CONCLUSIONS: Patients with teratoma at orchiectomy were associated with other high risk features and are at significant risk for metastatic disease. Patients with post-chemotherapy retroperitoneal findings are at significant risk for viable GCT and/or teratoma and should undergo PC-RPLND. Source of Funding: None
565 QUANTITATIVE ANALYSIS OF LYMPH NODE NUMBER RESECTED AT PRIMARY RETROPERITONEAL LYMPH NODE DISSECTION (RPLND) Michael Risk*, Stephen D.W. Beck, Richard Bihrle, Richard S. Foster, Indianapolis, IN INTRODUCTION AND OBJECTIVES: The quality of lymph node dissection has been shown to have both prognostic and therapeutic impact in a variety of cancers. Number of lymph nodes removed is a determinant of the quality of dissection in these cancers. We sought to quantify the number of lymph nodes removed at retroperitoneal lymph node dissection (RPLND) and identify variables predictive of lymph node counts. METHODS: From 1989 through 2008, 831 patients underwent primary RPLND for clinical stage A testicular cancer at our institution. Chart analysis was limited to patients undergoing either a right (n ⫽ 420) or left (n ⫽ 256) modified template. RESULTS: The mean number of lymph nodes (LNs) ⫹ SD obtained at RPLND for a right modified template was 18.7 ⫹/- 7.0 with a range of 4 to 50 and 17.5 ⫹/- 7.3 with a range of 2 to 43 for a left modified template. Nerve sparing and pathologic status did not significantly impact LN counts. Year of surgery was examined in 5-year increments, and those who had RPLND in 1999-2003 had significantly lower counts than the other 3 increments. Using case number within the
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series as a surrogate for pathologist experience, pathologists with ⬎50 cases had higher LN counts compared to those with ⬍50 cases (18.3 vs. 16.8, p⫽0.035). Surgeons with ⬎100 cases had higher LN counts than those with ⬍100 cases (18.5 vs. 17.2, p⫽0.026). Multivariate analysis revealed surgeon experience and year of surgery as the only variables predictive of LN count. CONCLUSIONS: Retroperitoneal LN counts obtained at RPLND are highly variable. Surgeon experience and year of surgery impacted LN counts though this is of uncertain clinical significance. The clinical impact of the number of lymph nodes removed at RPLND remains to be determined. Source of Funding: None
566 EVALUATION OF LYMPH NODE COUNTS IN PRIMARY RETROPERITONEAL LYMPH NODE DISSECTION R. Houston Thompson*, Byron, MN; Brett Carver, George Bosl, Dean Bajorin, Robert Motzer, Darren Feldman, Victor Reuter, Joel Sheinfeld, New York, NY INTRODUCTION AND OBJECTIVES: Lymph node counts are a measure of quality assurance and are associated with prognosis for numerous malignancies. To date, investigations of lymph node counts in testis cancer are lacking. METHODS: Using the Memorial Sloan-Kettering Testis Cancer Database, we identified 255 patients treated with primary retroperitoneal lymph node dissection (RPLND) for nonseminomatous germ cell tumors (NSGCT) between 1999 and 2008. Features associated with node counts, positive nodes, number of positive nodes, and risk of positive contralateral nodes were evaluated with regression models. RESULTS: Median (IQR) total node count was 38 (27 -53) and was 48 (34 – 61) during the most recent 5 years. Features associated with higher node count on multivariate analysis included high volume surgeon (p⫽0.034), clinical stage (p⫽0.036), and more recent year of surgery (p⬍0.001) while pathologist was not significantly associated with node count (p⫽0.3). Clinical stage (p⬍0.001) and total node count (p⫽0.045) were significantly associated with finding positive nodes on multivariate analysis. The probability of finding positive nodes were 23%, 23%, 31%, and 48% if the total node count was ⬍21, 21 – 40, 41 – 60, and ⬎60, respectively (Figure 1). With a median follow-up of 3.0 years all patients were still alive and 16 patients relapsed while no patient relapsed in the paracaval, interaortocaval, paraaortic, or iliac regions. CONCLUSIONS: Our results suggest that ⬎40 lymph nodes removed at RPLND improves the diagnostic efficacy of the operation. These results will be useful for future trials comparing RPLND, especially when assessing the adequacy of lymph node dissection.
Vol. 183, No. 4, Supplement, Sunday, May 30, 2010
567 LYMPH NODE YIELD AND NUMBER OF POSITIVE LYMPH NODES AFTER RPLND DOES NOT PREDICT CANCER-SPECIFIC SURVIVAL IN PATIENTS WITH NONSEMINOMATOUS GERM CELL TUMORS OF THE TESTIS Daniel Liberman*, Giovanni Lughezzani, Lars Badaus, Maxine Sun, Rodolphe Thuret, Wassim Kassouf, Philippe Arjane, Hugues Widmer, Francesco Montorsi, Shahrokh F. Shariat, Paul Perrotte, Pierre I. Karakiewicz, Montreal, Canada INTRODUCTION AND OBJECTIVES: There is much debate as to the prognostic significance of lymph node yield and positive number of lymph nodes within a retroperitoneal lymph node dissection (RPLND) specimen. We examined the effect of number of lymph node removed and examined and number of positive lymph nodes on cancer specific mortality within a population-based cohort of patients with nonseminomatous germ cell testicular tumors (NSGCTT). METHODS: Between 1988 and 2006, 1919 RPLNDs were performed within 17 Surveillance, Epidemiology and End Results (SEER) registries. Of these, 1024 (53.4%) were performed for stage I and 895 (46.6%) were performed for stage II NSGCTT. Univariable and multivariable Cox regression models tested the prognostic impact of either number of removed/examined lymph nodes or number of positive lymph nodes on cancer specific mortality. Analyses were adjusted for age, race (white, black, other), year of surgery (1988-1992, 1993-1997, 1998-2002, 2003-2006), socio-economic status (low vs. high) SEER stage (I vs. II) and SEER registry. RESULTS: The mean number of lymph nodes removed/examined was 21.9 (range: 1-96). The mean positive nodes were 1.6 (range:0-56) across all stages. The mean number of lymph nodes removed/examined and of positive lymph nodes were 21.3 and 22.6 vs. 0 and 3.4 for respective stages I and II NSGCTT. In univariable and multivariable Cox regression analyses neither number of lymph nodes removed/examined (p⫽0.6, p⫽0.8)) nor number of positive lymph nodes (p⫽0.7, p⫽0.2) were able to reach independent predictor status for cancer-specific mortality. Among covariates the only variable that was an independent predictor of cancer specific survival was advanced age (p⫽0.001). CONCLUSIONS: Cancer-specific mortality does not seem to be influenced by the number of nodes in the surgical specimen or the number of positive lymph nodes across stages I and II NSGCTT. Source of Funding: None
568 FERTILITY AFTER ADJUVANT SINGLE-AGENT CARBOPLATIN THERAPY FOR CLINICAL STAGE I SEMINOMA Nicolai Leonhartsberger*, Andreas Fritzer, Brigitte Stoehr, Florian Zangerl, Hannes Steiner, Innsbruck, Austria
Source of Funding: None
INTRODUCTION AND OBJECTIVES: Radiotherapy has been considered as standard adjuvant treatment for clinical Stage I seminoma for long time. The introduction of cisplatin-based chemotherapy has improved patient recovery dramatically. Although it is well known that carboplatin is a drug that binds directly to DNA, which is the presumptive method for killing cells, the mechanism of action of carboplatin on spermatozoa is unclear. Long-term toxicity becomes an important issue in this young age group of patients, and fertility especially has long-lasting consequences for their sexuality and quality of life. We analyzed the long-term damage to gonadal function and evaluated fertility of patients with clinical stage I seminoma after highdose chemotherapy. METHODS: Thirty patients patients with clinical stage I seminoma were treated with two postoperative adjuvant courses of carboplatin (400mg/m2 body surface area scheduled for days 1 and 22) in our hospital. Mean age was 38,4 years. All patients had histologically confirmed seminoma with resection margins free of tumor. Adjuvant chemotherapy was started approximately 14 days after operation. All patients underwent semen analysis more than 12 months after chemo-
cancer are reported. Categorical variables were compared using the chi-square or Fisher’s exact test. Logistic regression was used to assess factors that were associated with the presence of viable cancer. Survival analysis was performed using the Kaplan-Meier method, and comparisons were made using the log-rank test. RESULTS: Viable cancer was more prevalent in patients with increasing clinical stage, IGCCCG risk category, pre-chemotherapy mass size, pre-surgery mass size, elevated AFP, elevated HCG, and patients that received 2nd/3rd line vs. induction chemotherapy. Actuarial 5-year relapse free survival (RFS) was 62% (95% CI 49, 72). RFS was not significantly different between patients that received induction chemotherapy vs. 2nd/3rd line chemotherapy. Adjuvant chemotherapy significantly improved RFS rates in patients that received induction chemotherapy, but not in patients that received 2nd/3rd line chemotherapy prior to PC-RPLND. Actuarial 5-year disease specific survival (DSS) was 71% ( 95%CI 58,80). Disease specific survival was significantly worse in patients that received 2nd/3rd line chemotherapy (p⫽0.05). CONCLUSIONS: Following chemotherapy a significant number of patients with viable cancer are cured after surgery even in the setting of salvage chemotherapy. Surgery remains an integral component in the multidisciplinary treatment of patients with advanced GCTs. Cure can be achieved in 78% of patients after induction chemo and 58% of patients after salvage chemotherapy at 5 years. Source of Funding: None
563 OUTCOMES IN PATIENTS UNDERGOING POST-CHEMOTHERAPY RETROPERITONEAL LYMPH NODE DISSECTION FOR BULKY RETROPERITONEAL MASSES Eric Reid, Craig Nichols, Siamak Daneshmand*, Portland, OR INTRODUCTION AND OBJECTIVES: Up to 50% of patients who undergo induction chemotherapy for metastatic germ cell cancer have significant residual retroperitoneal disease requiring resection for complete cure. The goal of this study was to evaluate clinical outcomes for patients undergoing post-chemo retroperitoneal lymph node dissection (PC-RPLND) for bulky retroperitoneal masses. METHODS: We performed a retrospective analysis of all patients at our institution that underwent a PC-RPLND from October 2004 to October 2009. We reviewed their hospital course, pathology, preoperative imaging, and follow up data. Patients were separated into three groups based on the size of the residual retroperitoneal mass: Group 1, less than 5 cm in size, group 2, 5-10 cm in size, and group 3, greater than 10 cm in size. Bulky retroperitoneal masses were defined as those greater than 5 cm in size. Clinical outcomes were also analyzed for three separate time periods: Perioperative, early post-operative (⬍30 days) and late post-operative (⬎30 days). RESULTS: We identified 58 patients who met study criteria. A total of 60 operations were performed on these patients. Twenty-five patients had residual masses less than 5 cm in size, 24 patients had masses 5-10 cm in size, and 9 patients had a mass greater than 10 cm. Pathology on group 1 patients revealed 16% with residual cancer, 36% with teratoma, and 48% with fibrosis. These percentages changed for group 2 with 21% residual disease, 43% teratoma, and 36% fibrosis. One patient in group 3 (11%) had fibrosis while the 8 other patients had residual teratoma. Median blood loss was higher in groups 2 and 3 (1325 ml and 1050 ml versus 500 ml in group 1). The number of patients undergoing adjuvant procedures was also higher in groups 2 and 3 compared with group 1 (54% and 40% versus 24%). The percentages of early complications were 16%, 33%, and 40% in groups 1,2, and 3 respectively. Late complications were also slightly higher in groups 2(17%) and 3 (10%) than in group 1 (8%). No significant differences in the percentage of patients with disease recurrence were noted among groups 1,2, and 3(12%, 21% and 11%, respectively). CONCLUSIONS: Patients with bulky masses have slightly higher perioperative morbidity but no significant change in rate of
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disease recurrence. Masses greater than 10 cm are likely to be teratomas. Resection of bulky retroperitoneal masses warrants addition preoperative planning, but can be curative in the majority of cases. Source of Funding: None
564 PRIMARY VERSUS POST-CHEMOTHERAPY RETROPERITONEAL LYMPH NODE DISSECTION (RPLND) IN PATIENTS WITH PRESENCE OF TERATOMA AT ORCHIECTOMY Stephen Williams*, Belmont, MA; Ravi Kacker, Graeme Steele, Jerome Richie, Boston, MA INTRODUCTION AND OBJECTIVES: The presence of teratoma in the primary orchiectomy specimen creates controversies for subsequent management. Although teratoma predominant is less likely to metastasize, teratoma in the retroperitoneum may be less amenable to chemotherapy. In order to elucidate the issues about teratoma in the primary tumor, we reviewed differences between primary retroperitoneal lymph node dissection (P-RPLND) versus post-chemotherapy RPLND (PC-RPLND) in patients with teratoma at orchiectomy. METHODS: Patients who had undergone RPLND at our institution from 2001 to 2008 were identified and clinical charts reviewed. 83 patients with teratoma at orchiectomy were identified and peri-operative data was obtained. RESULTS: Of the 83 patients with teratoma at orchiectomy who underwent RPLND, 44 (53%) and 39 (47%) underwent primary and PC-RPLND, respectively. Median follow-up was 1.4 years. In addition to teratoma in the primary tumory, 37 (45%) patients had embryonal carcinoma and 32 (39%) had lymphovascular invasion (LVI). There were 19 (43%) positive lymph nodes for P-RPLND of which 13 (68.4%) contained teratoma. For the PC-RPLND group, 30 (77%) of lymph nodes were positive of which 28 (93.3%) contained teratoma. There were 3 (4%) recurrences overall, all of which recurred in the PCRPLND group. There were 11 (13%) perioperative complications total. There were no deaths in either group. CONCLUSIONS: Patients with teratoma at orchiectomy were associated with other high risk features and are at significant risk for metastatic disease. Patients with post-chemotherapy retroperitoneal findings are at significant risk for viable GCT and/or teratoma and should undergo PC-RPLND. Source of Funding: None
565 QUANTITATIVE ANALYSIS OF LYMPH NODE NUMBER RESECTED AT PRIMARY RETROPERITONEAL LYMPH NODE DISSECTION (RPLND) Michael Risk*, Stephen D.W. Beck, Richard Bihrle, Richard S. Foster, Indianapolis, IN INTRODUCTION AND OBJECTIVES: The quality of lymph node dissection has been shown to have both prognostic and therapeutic impact in a variety of cancers. Number of lymph nodes removed is a determinant of the quality of dissection in these cancers. We sought to quantify the number of lymph nodes removed at retroperitoneal lymph node dissection (RPLND) and identify variables predictive of lymph node counts. METHODS: From 1989 through 2008, 831 patients underwent primary RPLND for clinical stage A testicular cancer at our institution. Chart analysis was limited to patients undergoing either a right (n ⫽ 420) or left (n ⫽ 256) modified template. RESULTS: The mean number of lymph nodes (LNs) ⫹ SD obtained at RPLND for a right modified template was 18.7 ⫹/- 7.0 with a range of 4 to 50 and 17.5 ⫹/- 7.3 with a range of 2 to 43 for a left modified template. Nerve sparing and pathologic status did not significantly impact LN counts. Year of surgery was examined in 5-year increments, and those who had RPLND in 1999-2003 had significantly lower counts than the other 3 increments. Using case number within the
e222
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series as a surrogate for pathologist experience, pathologists with ⬎50 cases had higher LN counts compared to those with ⬍50 cases (18.3 vs. 16.8, p⫽0.035). Surgeons with ⬎100 cases had higher LN counts than those with ⬍100 cases (18.5 vs. 17.2, p⫽0.026). Multivariate analysis revealed surgeon experience and year of surgery as the only variables predictive of LN count. CONCLUSIONS: Retroperitoneal LN counts obtained at RPLND are highly variable. Surgeon experience and year of surgery impacted LN counts though this is of uncertain clinical significance. The clinical impact of the number of lymph nodes removed at RPLND remains to be determined. Source of Funding: None
566 EVALUATION OF LYMPH NODE COUNTS IN PRIMARY RETROPERITONEAL LYMPH NODE DISSECTION R. Houston Thompson*, Byron, MN; Brett Carver, George Bosl, Dean Bajorin, Robert Motzer, Darren Feldman, Victor Reuter, Joel Sheinfeld, New York, NY INTRODUCTION AND OBJECTIVES: Lymph node counts are a measure of quality assurance and are associated with prognosis for numerous malignancies. To date, investigations of lymph node counts in testis cancer are lacking. METHODS: Using the Memorial Sloan-Kettering Testis Cancer Database, we identified 255 patients treated with primary retroperitoneal lymph node dissection (RPLND) for nonseminomatous germ cell tumors (NSGCT) between 1999 and 2008. Features associated with node counts, positive nodes, number of positive nodes, and risk of positive contralateral nodes were evaluated with regression models. RESULTS: Median (IQR) total node count was 38 (27 -53) and was 48 (34 – 61) during the most recent 5 years. Features associated with higher node count on multivariate analysis included high volume surgeon (p⫽0.034), clinical stage (p⫽0.036), and more recent year of surgery (p⬍0.001) while pathologist was not significantly associated with node count (p⫽0.3). Clinical stage (p⬍0.001) and total node count (p⫽0.045) were significantly associated with finding positive nodes on multivariate analysis. The probability of finding positive nodes were 23%, 23%, 31%, and 48% if the total node count was ⬍21, 21 – 40, 41 – 60, and ⬎60, respectively (Figure 1). With a median follow-up of 3.0 years all patients were still alive and 16 patients relapsed while no patient relapsed in the paracaval, interaortocaval, paraaortic, or iliac regions. CONCLUSIONS: Our results suggest that ⬎40 lymph nodes removed at RPLND improves the diagnostic efficacy of the operation. These results will be useful for future trials comparing RPLND, especially when assessing the adequacy of lymph node dissection.
Vol. 183, No. 4, Supplement, Sunday, May 30, 2010
567 LYMPH NODE YIELD AND NUMBER OF POSITIVE LYMPH NODES AFTER RPLND DOES NOT PREDICT CANCER-SPECIFIC SURVIVAL IN PATIENTS WITH NONSEMINOMATOUS GERM CELL TUMORS OF THE TESTIS Daniel Liberman*, Giovanni Lughezzani, Lars Badaus, Maxine Sun, Rodolphe Thuret, Wassim Kassouf, Philippe Arjane, Hugues Widmer, Francesco Montorsi, Shahrokh F. Shariat, Paul Perrotte, Pierre I. Karakiewicz, Montreal, Canada INTRODUCTION AND OBJECTIVES: There is much debate as to the prognostic significance of lymph node yield and positive number of lymph nodes within a retroperitoneal lymph node dissection (RPLND) specimen. We examined the effect of number of lymph node removed and examined and number of positive lymph nodes on cancer specific mortality within a population-based cohort of patients with nonseminomatous germ cell testicular tumors (NSGCTT). METHODS: Between 1988 and 2006, 1919 RPLNDs were performed within 17 Surveillance, Epidemiology and End Results (SEER) registries. Of these, 1024 (53.4%) were performed for stage I and 895 (46.6%) were performed for stage II NSGCTT. Univariable and multivariable Cox regression models tested the prognostic impact of either number of removed/examined lymph nodes or number of positive lymph nodes on cancer specific mortality. Analyses were adjusted for age, race (white, black, other), year of surgery (1988-1992, 1993-1997, 1998-2002, 2003-2006), socio-economic status (low vs. high) SEER stage (I vs. II) and SEER registry. RESULTS: The mean number of lymph nodes removed/examined was 21.9 (range: 1-96). The mean positive nodes were 1.6 (range:0-56) across all stages. The mean number of lymph nodes removed/examined and of positive lymph nodes were 21.3 and 22.6 vs. 0 and 3.4 for respective stages I and II NSGCTT. In univariable and multivariable Cox regression analyses neither number of lymph nodes removed/examined (p⫽0.6, p⫽0.8)) nor number of positive lymph nodes (p⫽0.7, p⫽0.2) were able to reach independent predictor status for cancer-specific mortality. Among covariates the only variable that was an independent predictor of cancer specific survival was advanced age (p⫽0.001). CONCLUSIONS: Cancer-specific mortality does not seem to be influenced by the number of nodes in the surgical specimen or the number of positive lymph nodes across stages I and II NSGCTT. Source of Funding: None
568 FERTILITY AFTER ADJUVANT SINGLE-AGENT CARBOPLATIN THERAPY FOR CLINICAL STAGE I SEMINOMA Nicolai Leonhartsberger*, Andreas Fritzer, Brigitte Stoehr, Florian Zangerl, Hannes Steiner, Innsbruck, Austria
Source of Funding: None
INTRODUCTION AND OBJECTIVES: Radiotherapy has been considered as standard adjuvant treatment for clinical Stage I seminoma for long time. The introduction of cisplatin-based chemotherapy has improved patient recovery dramatically. Although it is well known that carboplatin is a drug that binds directly to DNA, which is the presumptive method for killing cells, the mechanism of action of carboplatin on spermatozoa is unclear. Long-term toxicity becomes an important issue in this young age group of patients, and fertility especially has long-lasting consequences for their sexuality and quality of life. We analyzed the long-term damage to gonadal function and evaluated fertility of patients with clinical stage I seminoma after highdose chemotherapy. METHODS: Thirty patients patients with clinical stage I seminoma were treated with two postoperative adjuvant courses of carboplatin (400mg/m2 body surface area scheduled for days 1 and 22) in our hospital. Mean age was 38,4 years. All patients had histologically confirmed seminoma with resection margins free of tumor. Adjuvant chemotherapy was started approximately 14 days after operation. All patients underwent semen analysis more than 12 months after chemo-