664 OUTCOME OF VIABLE SEMINOMA AT POSTCHEMOTHERAPY RETROPERITONEAL LYMPH NODE DISSECTION

Vol. 187, No. 4S, Supplement, Sunday, May 20, 2012

CONCLUSIONS: Adjuvant RT emerged as the only negative predictor of long-term recovery of normal erectile function and sexual desire in TGCC survivors. Source of Funding: None

664 OUTCOME OF VIABLE SEMINOMA AT POSTCHEMOTHERAPY RETROPERITONEAL LYMPH NODE DISSECTION Kevin Rice*, Stephen Beck, Richard Bihrle, Einhorn Lawrence, Richard Foster, Indianapolis, IN INTRODUCTION AND OBJECTIVES: The presence of viable seminoma at postchemotherapy retroperitoneal lymph node dissection (PC-RPLND) is rare due to the chemosensitivity of this germ cell tumor. Thus, behavior of residual seminoma has not been well established. At Indiana University, PC-RPLND is performed only on the rare seminoma patient that demonstrates radiographic or serologic evidence of progression after chemotherapy. The purpose of this study is to define the clinicopathologic behavior of viable seminoma at PC-RPLND. METHODS: The Indiana University Testis Cancer Database was queried from 1988 to 2011 to identify all patients with primary testicular or extragonadal pure seminoma and demonstrating pure seminoma at PC-RPLND. Clinicopathologic and treatment characteristics were reviewed. Survival analysis was performed. RESULTS: 37 patients met the inclusion criteria. Mean patient age at diagnosis was 37.4 years. Three, 20, and 13 patients presented initially with clinical stage I, II, and III disease, respectively. Staging information was unavailable in 1 patient. All but 1 patient had good risk disease. Thirty-one patients were managed primarily with cisplatinbased chemotherapy. Three patients each were primarily managed with surveillance and external beam radiation, respectively. Fifteen patients received second line chemotherapy, 1 of whom subsequently received high-dose chemotherapy (HDCT) prior to PC-RPLND. The decision to proceed to surgical resection was based on radiologic or serologic evidence of progression after chemotherapy. The mean tumor size at PC-RPLND was 5.7 cm. Seven patients had undergone previous RPLND. Twelve patients had elevated human chorionic gonadotropin at the time of surgery. Postoperative chemotherapy was administered in 18 patients. Median follow-up was 65 months. At last follow-up, 16 patients (43.2%) had died of disease and 20 patients (56.8%) had no evidence of disease (NED), including 1 patient who died of an unrelated cause at 93 months. The mean time from PCRPLND to death was 6.9 months (3-16 months). Second line chemotherapy was the only variable that predicted cancer specific death on both univariate (p ⫽ 0.013) and multivariate (p ⫽ 0.012) analyses. CONCLUSIONS: In this heavily pretreated patient population, 56.8% of patients with viable seminoma at PC-RPLND were NED at last follow-up. Source of Funding: None

665 LATE RECURRENCE IN PATIENTS WITH HISTORY OF COMPLETE REMISSION OF METASTATIC GERM CELL TUMORS TO CHEMOTHERAPY Kevin Rice*, Stephen Beck, Paul Johnston, Richard Bihrle, Einhorn Lawrence, Richard Foster, Indianapolis, IN INTRODUCTION AND OBJECTIVES: Late recurrence (LR) of germ cell tumors (GCT) is rare. Previous studies have reported improved outcomes in chemotherapy naı¨ve patients. The purpose of this study is to determine outcomes in LR patients who have not undergone previous retroperitoneal lymph node dissection (RPLND). METHODS: The Indiana University Testis Cancer Database was queried from 1991 to 2010 to identify all patients having undergone postchemotherapy (PC) RPLND 2 or more years after experiencing a

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complete response (CR) to systemic chemotherapy. Patients were excluded if the had undergone prior RPLND. Clinicopathologic and treatment characteristics were reviewed. Survival analysis was performed. RESULTS: 26 patients met inclusion criteria. The mean age at diagnosis was 31.3 years. All cases were nonseminomatous GCTs. The median time from CR to LR was 60.5 months (range, 29 to 163). At LR Alpha-fetoprotein (AFP) was elevated in 16 patients and 1 patient had elevation of both AFP and human chorionic gonadotropin. Site of relapse included the retroperitoneum (RP) in 25 patients. Three of these patients also had pelvic relapse, 1 had supraclavicular relapse, and 1 had thoracic relapse. One patient had pelvic relapse alone. Systemic chemotherapy was administered at LR prior to referral to Indiana University in 8 patients. All 26 patients underwent PC-RPLND. Pathology revealed teratoma only in 11, yolk sac tumor in 10, embryonal carcinoma in 2, sarcoma in 1, and necrosis in 2 patients. Mean diseasefree survival (DFS) for the entire cohort was 69.1 months. Cancer specific survival (CSS) from LR was 76.5% at a median follow-up of 68 months (Range, 1 to 124 months). The CSS was 87.5% at a median follow-up of 70 months and 50% at a median follow-up of 72 months for patients with teratoma only and yolk sac tumor, respectively (p ⫽0.034). At most recent follow-up, 17 patients had no evidence of disease (NED), 5 patients had died of disease, and 4 patients were alive with disease at 5, 12, 13, and 72 months. On both univariate and multivariate analysis histology of LR was predictive of DFS, but not CSS. CONCLUSIONS: LR in testis cancer patients having previously achieved complete remission to chemotherapy alone without surgical consolidation is associated with improved survival compared to historical outcomes for all patients experiencing LR. The most important prognostic factor at LR appears to be histology. Source of Funding: None

666 A NOVEL RISK STRATIFICATION SYSTEM FOR CHEMOTHERAPY FAILURE IN TESTICULAR GERM CELL TUMOR Jessica Lubahn*, Nicholas Cost, Mehrad Adibi, Adam Romman, Ganesh Raj, Arthur Sagalowsky, Vitaly Margulis, Dallas, TX INTRODUCTION AND OBJECTIVES: The initial management of testicular germ cell tumor (T-GCT) is tailored by TNMS staging to surveillance, retroperitoneal lymph node dissection (RPLND), platinumbased chemotherapy (CT), or radiation. Risk stratification according to the International Germ Cell Collaborative Group classification (IGCCG) determines the CT regimen. We present a novel classification system, which can be easily used to predict CT failure (CT-F). METHODS: We reviewed an institutional T⫺GCT database and selected patients who had undergone any CT. CT-F was defined as tumor marker elevation following normalization, receiving any salvage CT, or presence of active GCT in post-CT RPLND. CT-F patients were compared to those successfully treated with CT (CT-S). Factors predictive of CT-F on univariate analysis were used to develop a risk scoring system (RSS). One point was allotted to each risk factor and summed into an overall score. The prognostic ability of the RSS was compared to the IGCCG by constructing Receiver Operating Curves (ROC). RESULTS: 205 patients were reviewed (153 CT-S, 52 CT-F). Factors predictive of CT-F included post-orchiectomy AFP and HCG, number of metastatic sites, N and M status. Non-significant factors included histology (seminoma v non-seminoma), initial treatment modality, and T stage. The RSS, derived from the mean tumor marker values in the CT-F group, consisted of the following criteria: AFP⬎3000, HCG⬎50,000, LDH⬎800, N3, non-pulmonary visceral metastasis, and ⬎3 metastatic sites. The RSS distribution was obtained for CT-S and CT-F (p⫽0.00) respectively: 0: 101(89.4%) vs. 12(10.6%), 1:39(71.0%) vs. 16(29.0%), 2: 4(30.8%) vs. 9(69.2%), ⬎3: 2(14.3%) vs. 12(85.7%). The hazard ratios for scores 1,2, and ⬎3 were 2.53, 6.62, and 22.2 respectively (p⫽0.00). The figure depicts time to CT-F, stratified by RSS. The