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Incidence and clinical outcome of patients with teratoma in the retroperitoneum following primary retroperitoneal lymph node dissection for clinical stages I and IIA nonseminomatous germ cell tumors
R.G. Rowland / Urologic Oncology: Seminars and Original Investigations 22 (2004) 157–164
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by a 5-year disease-free survival rate of 86% for those patients reoperated upon after primary RPLND and 56% after post-chemotherapy RPLND. These rates are greater in general than the use of second-line chemotherapy. Also, since teratoma was the most frequent histologic finding in the repeat RPLND specimens, many patients in this overall group would have failed to respond to chemotherapy. doi:10.1016/j.urolonc.2004.02.008 Randall G. Rowland, M.D., Ph.D.
Incidence and clinical outcome of patients with teratoma in the retroperitoneum following primary retroperitoneal lymph node dissection for clinical stages I and IIA nonseminomatous germ cell tumors. Sheinfeld J, Motzer RJ, Rabbani F, McKiernan J, Bajorin D, Bosl GJ, Department of Urology, Memorial Sloan-Kettering Cancer Center, New York, NY. J Urol 2003;170:1159 – 62 Purpose: We determined the incidence and clinical outcome of patients with clinical stages I and IIA nonseminomatous germ cell tumors (NSGCT), and teratoma in the retroperitoneum following primary retroperitoneal lymph node dissection (RPLND). Materials and Methods: Between January 1989 and February 1998, 294 patients with clinical stages I (209) and IIA (85) underwent primary RPLND at our institution. The primary tumor had teratomatous elements in 179 (61%) cases. Median followup was 27.8 months. Results: The overall incidence of teratoma in the retroperitoneum was 9% (25 of 294), and 21% (25 of 118) in patients with pathological stage II disease. The incidence of teratoma in the retroperitoneum increased from 3% (6 of 209) in clinical stage I to 22% (19 of 85, chi-square test p ⬍ 0.0001) in clinical stage IIA. The incidence of teratoma in patients with pN1/N2/N3 disease increased from 9% (6 of 64) in clinical stage I to 35% (19 of 54) in clinical stage IIA (chi-square test p ⫽ 0.0006). All 25 patients with pathological stage II and teratoma in the retroperitoneum have no evidence of disease. Conclusions: The incidence of teratoma in the retroperitoneum increases with clinical and pathological stage. Teratomatous elements in the orchiectomy specimen predict teratoma in clinical and pathological stage II NSGCT. The absence of teratoma in the primary tumor does not preclude its presence in the retroperitoneum. Primary RPLND avoids the persistence of chemoresistant teratoma in the retroperitoneum, contributes to the high cure rate of patients with low stage NSGCT and decreases the potential for late relapse.
Commentary This is a series of 294 patients who had primary RPLND for clinical stages I and IIA nonseminomatous germ cell tumors (NSGCT) with analysis and emphasis on 179 (61%) patients with teratomatous elements in the primary tumor. The authors observed that teratomatous elements in the primary tumor were predictive of teratoma in the retroperitoneal nodes; however, the lack of teratomatous elements in the primary tumor did not preclude the existence of teratoma in the retroperitoneal nodes. The incidence of teratoma in the retroperitoneal nodes increased with clinical stage and the “N” stage. Primary RPLND does have the advantage of removing chemorefractive teratomatous elements in the retroperitoneum, which contributes to the very high cure rate of stages I and IIA patients. doi:10.1016/j.urolonc.2004.02.010 Randall G. Rowland, M.D., Ph.D.
Postchemotherapy retroperitoneal surgery remains necessary in patients with nonseminomatous testicular cancer and minimal residual tumor masses. Oldenburg J, Alfsen GC, Lien HH, Aass N, Waehre H, Fossa SD, Department of Medical Oncology, The Norwegian Radium Hospital, Montebello, Oslo, Norway. J Clin Oncol 2003;21:3310 –7 Purpose: To determine preoperative parameters that predict the histology of specimens obtained by retroperitoneal lymph node dissection (RPLND) in patients with nonseminomatous germ cell cancer (NSGCT) whose residual mass was ⱕ20 mm in diameter after modern cisplatin-based induction chemotherapy. Patients and Methods: Eighty-seven patients with metastatic NSGCT underwent RPLND after having received cisplatin- or carboplatinbased induction chemotherapy. In all patients, the largest diameter of the residual mass on the transaxial plane was ⱕ20 mm, as assessed by abdominal computed tomography (CT) immediately before RPLND. Results: Complete fibrosis or necrosis was found in 58 patients (67%), teratoma was found in 23 patients (26%), and vital malignant germ cell tumor was found in six patients (7%), including one patient with rhabdomyosarcoma in the RPLND specimen. In five of the six latter patients, the residual lesion was ⱕ10 mm at pre-RPLND CT. No pre- or postchemotherapy clinical or radiologic parameter was identified that significantly predicted the histology of the residual mass. Conclusion: One-third of retroperitoneal postchemotherapy lesions ⱕ20 mm contained residual vital tumor tissue, despite modern chemotherapy regimens. Therefore, postchemotherapy RPLND remains necessary in patients with minimal-size residual lesions to facilitate easy and safe follow-up and initiate additional therapy as early as possible, thus avoiding recurrences.
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by a 5-year disease-free survival rate of 86% for those patients reoperated upon after primary RPLND and 56% after post-chemotherapy RPLND. These rates are greater in general than the use of second-line chemotherapy. Also, since teratoma was the most frequent histologic finding in the repeat RPLND specimens, many patients in this overall group would have failed to respond to chemotherapy. doi:10.1016/j.urolonc.2004.02.008 Randall G. Rowland, M.D., Ph.D.
Incidence and clinical outcome of patients with teratoma in the retroperitoneum following primary retroperitoneal lymph node dissection for clinical stages I and IIA nonseminomatous germ cell tumors. Sheinfeld J, Motzer RJ, Rabbani F, McKiernan J, Bajorin D, Bosl GJ, Department of Urology, Memorial Sloan-Kettering Cancer Center, New York, NY. J Urol 2003;170:1159 – 62 Purpose: We determined the incidence and clinical outcome of patients with clinical stages I and IIA nonseminomatous germ cell tumors (NSGCT), and teratoma in the retroperitoneum following primary retroperitoneal lymph node dissection (RPLND). Materials and Methods: Between January 1989 and February 1998, 294 patients with clinical stages I (209) and IIA (85) underwent primary RPLND at our institution. The primary tumor had teratomatous elements in 179 (61%) cases. Median followup was 27.8 months. Results: The overall incidence of teratoma in the retroperitoneum was 9% (25 of 294), and 21% (25 of 118) in patients with pathological stage II disease. The incidence of teratoma in the retroperitoneum increased from 3% (6 of 209) in clinical stage I to 22% (19 of 85, chi-square test p ⬍ 0.0001) in clinical stage IIA. The incidence of teratoma in patients with pN1/N2/N3 disease increased from 9% (6 of 64) in clinical stage I to 35% (19 of 54) in clinical stage IIA (chi-square test p ⫽ 0.0006). All 25 patients with pathological stage II and teratoma in the retroperitoneum have no evidence of disease. Conclusions: The incidence of teratoma in the retroperitoneum increases with clinical and pathological stage. Teratomatous elements in the orchiectomy specimen predict teratoma in clinical and pathological stage II NSGCT. The absence of teratoma in the primary tumor does not preclude its presence in the retroperitoneum. Primary RPLND avoids the persistence of chemoresistant teratoma in the retroperitoneum, contributes to the high cure rate of patients with low stage NSGCT and decreases the potential for late relapse.
Commentary This is a series of 294 patients who had primary RPLND for clinical stages I and IIA nonseminomatous germ cell tumors (NSGCT) with analysis and emphasis on 179 (61%) patients with teratomatous elements in the primary tumor. The authors observed that teratomatous elements in the primary tumor were predictive of teratoma in the retroperitoneal nodes; however, the lack of teratomatous elements in the primary tumor did not preclude the existence of teratoma in the retroperitoneal nodes. The incidence of teratoma in the retroperitoneal nodes increased with clinical stage and the “N” stage. Primary RPLND does have the advantage of removing chemorefractive teratomatous elements in the retroperitoneum, which contributes to the very high cure rate of stages I and IIA patients. doi:10.1016/j.urolonc.2004.02.010 Randall G. Rowland, M.D., Ph.D.
Postchemotherapy retroperitoneal surgery remains necessary in patients with nonseminomatous testicular cancer and minimal residual tumor masses. Oldenburg J, Alfsen GC, Lien HH, Aass N, Waehre H, Fossa SD, Department of Medical Oncology, The Norwegian Radium Hospital, Montebello, Oslo, Norway. J Clin Oncol 2003;21:3310 –7 Purpose: To determine preoperative parameters that predict the histology of specimens obtained by retroperitoneal lymph node dissection (RPLND) in patients with nonseminomatous germ cell cancer (NSGCT) whose residual mass was ⱕ20 mm in diameter after modern cisplatin-based induction chemotherapy. Patients and Methods: Eighty-seven patients with metastatic NSGCT underwent RPLND after having received cisplatin- or carboplatinbased induction chemotherapy. In all patients, the largest diameter of the residual mass on the transaxial plane was ⱕ20 mm, as assessed by abdominal computed tomography (CT) immediately before RPLND. Results: Complete fibrosis or necrosis was found in 58 patients (67%), teratoma was found in 23 patients (26%), and vital malignant germ cell tumor was found in six patients (7%), including one patient with rhabdomyosarcoma in the RPLND specimen. In five of the six latter patients, the residual lesion was ⱕ10 mm at pre-RPLND CT. No pre- or postchemotherapy clinical or radiologic parameter was identified that significantly predicted the histology of the residual mass. Conclusion: One-third of retroperitoneal postchemotherapy lesions ⱕ20 mm contained residual vital tumor tissue, despite modern chemotherapy regimens. Therefore, postchemotherapy RPLND remains necessary in patients with minimal-size residual lesions to facilitate easy and safe follow-up and initiate additional therapy as early as possible, thus avoiding recurrences.