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S52 Pathologic findings and clinical outcome of patients undergoing retroperitoneal lymphadenectomy after multiple chemotherapy regimens for metastatic nonseminomatous testicular tumors
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eau 5th south eastern european meeting (seem) / european urology supplements 8 (2009) 607–655
Conclusions: We consider that in children the overactive bladder is a common condition, characterized by sharp decrease of the quality of life and social adaptation, and because of it its treatment is obligatory. According to us the main method of diagnosis and follow up is the non-invasive urodynamics, and medication is main treatment of choice.
Poster Session 4: Testicular cancer, infertility, erectile dysfunction Friday, 9 October 2009, 15:20–17:30 Room 1 S50 Frequency of retroperitoneal metastasis and comparison of pathohistological findings of primary testicular tumor and retroperitoneal metastasis S. Zivojinov1 *, M. Zivojinov2 , N. Dejanovic3 , S. Vojinov3 , G. Marusic3 , D. Jeremic3 . 1 Clinical Center Vojvodina, Department of Urology, Novi Sad, Serbia; 2 Clinical Center Vojvodina, Dept. of Pathology, Novi Sad, Serbia; 3 Clinical Center Vojvodina, Dept. of Urology, Novi Sad, Serbia Introduction and Objectives: Objective is to compare pathohistological finding of testicular tumor with type of metastasis in retroperitoneal lymph nodes, when is well known that these tumors bring lymphogenic metastasis first. Because these tumors originated of totipotent cells, pathohistological finding of primary tumor and metastasis can be significantly different. Material and Methods: In period of 2004–2009, in Department of Urology, Clinical Center Vojvodina was performed 48 retroperitoneal lymphadenectomy. In that number, there were 25 bilateral and 20 unilateral, and last 3 was reoperation of suspicious relapse after previous lymphadenectomy. Diagnostic algorithm comprise: determination of tumor markers before and after inguinal orchiectomy, pathohistological finding of primary tumor, CT scans of abdomen and pelvis, and in selective cases also CT scan of lungs. After that, multidiscipline team selects therapy (watchful waiting, chemotherapy, surgery – retroperitoneal lymphadenctomy, radiotherapy) Results: Most common primary tumor was seminoma, embryonal carcinoma and mixed tumors (with several pathohistologic types). Retroperitoneal metastasis was discovering in 19 of 48 patients (39.58%). The same pathohistological finding in metastasis as well in primary tumor was discovering in 78.95% patients. In one patient, in which case was perform relymphadenectomy, type of malignant tumor was not precise defined, and in last 3 patients was discovered teratoma although primary tumor was embryonal carcinoma. In 3 patients with mixed primary tumor, metastasis contained only one pathohistological type, and that one was less present component in primary tumor. In 16 patients in which weren’t discovered tumor, exist focuses of necrosis and chronic reactive lymphadenitis. Conclusions: Significant number of patients has retroperitoneal metastasis. Also, great number of patients has focuses of necrosis in removed retroperitoneal lymph nodes. In most patients with metastasis, tumor in metastasis was the same one as in primary testicular tumor. Only in one case, when relymphadenectomy was performed, pathohistological type of tumor wasn’t precise diagnosed with standard pathohistological analysis.
S51 Management of clinical stage A, B1 and B2 with nonseminomatous testicular tumors avoiding upfront retroperitoneal lymphadenectomy D. Argirovic1 *, A. Argirovic2 . 1 Clinic of Urology, Outpatient Clinic Argirovic, Urology, Belgrade, Serbia; 2 Kbc Zemun, Urology, Belgrade, Serbia Introduction and Objectives: Patients (pts) in clinical stage (CS) A, B1 and B2 nonseminomatous testicular tumors (NSTT) may be treated by either retroperitoneal lymphadenectomy (RPLA) + chemotherapy (CT) in selected cases or with primary cisplatin (CDDP)-based CT followed by surgery in pts with residual disease (ds). Material and Methods: We treated between 1980 and 2005 in the prospective but non-randomized study 650 pts in low CS NSTT. The pts are divided into 2 groups according to primary treatment: Arm A (n = 170) managed with RPLA ± CT and Arm B (n = 480) with primary CDDP-based CT ± surgery. Results: 24 pts with low risk (LR) (<50% EC, no VI) in Arm A had universal survival at median follow-up (MFU) of 16.6 years (y) with 2 pts (8%) with LN metastasis necessitating CT vs 6/40 pts (15%) relapsing on surveillance who achieved CR with CT alone at MFU of 13.5 y (p < 0.042). In high risk group (>50% EC, VI+) relapse rate (RR) occurred in 10/60 pts (17%) in Arm A vs 2/78 (3%) managed with 2 cycles of CT following orhiectomy (p < 0.0036) necessitating salvage CT + lung surgery (vital GCT 2) in Arm B, with DSS in 93% and 99% (p < 0.0416), at MFU of 14.5 and 8.5 y, respectively. In Arm A, 21 pts (35%) necessitate CT post-RPLA (7 in PS-A due to relapse and 14 due to LN metastasis) (p < 0.0013) without difference in RR (14% vs 21%) (p = 0.585). Overall in pts with persistently elevated STM post-orchiectomy there was lower occurrence of RR (33% vs 9%) (p < 0.0094) in favor of Arm B but DSS did not differ significantly (95% vs 97%) (p = 0.660) at MFU of 15.8 and 15.6 y, respectively. In Arm B, 13 pts (7%) necessitated RPLA due to progression (fibrosis 15%, teratoma 62%, vital GCT 23%) (favorable histology had universal DSS vs no survival with vital GCT). Overall in CS B1/B2, RR was 14 vs 8% (P = 0.1774) and DSS in 90% vs 96% (P = 0.395), at MFU of 18.3 and 12.9 y, respectively. In Arm A, CS B1 vs B2 were characterized with RR of 5% vs 24% (p = 0.779) and DSS in 100% vs 81% (p < 0.055) at MFU of 17.4 and 19.1 y, respectively. In arm B PCT-RPLA was indicated in 40 pts (12%) (fibrosis 22%, teratoma 61%, Vital GCT 17%). Favorable vs worse histology occurred in relation of 83% vs 17% (p < 0.001) and predicted unfavorable DSS (100% vs 43%) (p < 0.0001). Analysis of 480 pts in Arm A, managed with surveillance in LR CS-A NSTT and primary CT ± surgery in the remaining 440 pts, demonstrated low RR (8%), excellent DSS (98%), whereas surgery was indicated in only 11% pts. Statistical analysis failed to demonstrate significant difference regarding RR and DSS between Arm A and B, except the need for adjuvant therapy (CT vs surgery) (55% vs 11%) (p < 0.00001). Conclusions: Primary CT is feasible mode of treatment in pts with low CS NSTT without substantially increasing the proportion of pts exposed to surgery. S52 Pathologic findings and clinical outcome of patients undergoing retroperitoneal lymphadenectomy after multiple chemotherapy regimens for metastatic nonseminomatous testicular tumors D. Argirovic1 *, V. Stanic2 , A. Argirovic3 . 1 Clinic of Urology, Outpatient Clinic Argirovic, Urology, Belgrade, Serbia; 2 Military Medical Academy, Thoracic Surgery, Belgrade, Serbia; 3 Kbc Zemun, Urology, Belgrade, Serbia Introduction and Objectives: We reviewed our experience with retroperitoneal lymphadenectomy (RPLA) after multiple
eau 5th south eastern european meeting (seem) / european urology supplements 8 (2009) 607–655
cisplatin (CDDP)-based chemotherapy (CT) regimens in nonseminomatous testicular tumors (NSTT) patients (pts) and specifically evaluated clinic-pathologic and treatment trend in addition to potential predictors of survival. Material and Methods: 41 pts with NSTT underwent their RPLA between 1980 and 2005 after >2 regimens of CT. 13 pts (32%) necessitate redo-RPLA, combined with nephrectomy in pts. 13 extra-RP resections were performed in 11 pts (27%), including pulmonary (7), neck (4) and liver (2) sites. Results: 30 pts (73%) are rendered grossly free of disease (ds) and 26 (63%) obtained serologic remission. 9 pts who relapsed within MFI of 28 months (m) (RPLN 8, RPLN+lung 1) necessitated CT+surgery (3 teratoma, 6 vital GCT). 4/9 relapsing pts (44%) are currently free of ds with redo-RPLA. Alive, free of ds are 19 pts (46%) at MFU of 131 m. Study of RP pathology demonstrated the presence of fibrosis in 15%, teratoma in 39% and vital GCT in 46%, with survival in 67%, 56%, and 32%, respectively. Worse vs favourable histology occurred in relation of 32% vs 59% (p < 0.05). Different histology occurred in 38% at redo-RPLA and in 64% at ERP resection in comparison to previous RP pathology (p = 0.219). Univariate analysis of clinicopathologic parameters associated with vital GCT at RPLA included RP mass >5 cm (p < 0.05), elevated AFP (p < 0.001) or HCG (p < 0.05) and ERP resection (p < 0.04). On univariate analysis survival was worse in pts with RP masses >5 cm (p < 0.04), elevated AFP (p < 0.05) or HCG (p < 0.007), ERP resection (p < 0.01), and vital GCT (p < 0.004). On multivariable analysis, a RP mass >5 cm (p < 0.03) and vital GCT (p < 0.005) predicted a worse prognosis. Vital GCT either in the RP or in ERP sites predicted worse prognosis (p = 0.001). Conclusions: Our data support the continued use of salvage RPLA in 3 separated groups of pts: 1. Pts who achieved a CR on 2nd line CT and have no radiologic evidence of ds should undergo RPLA; 2. Pts who achieved a PR to CT should undergo RPLA with ERP surgery, as indicated; 3. Highly selected pts with residual mass and elevated STM, particularly AFP, after CT may be candidates for surgery. S53 The impact of residual extra-retroperitoneal masses in patients with advanced nonseminomatous testicular tumors D. Argirovic1 *, V. Stanic2 , A. Argirovic3 . 1 Clinic of Urology, Outpatient Clinic Argirovic, Urology, Belgrade, Serbia; 2 Military Medical Academy, Thoracic Surgery, Belgrade, Serbia; 3 Kbc Zemun, Urology, Belgrade, Serbia Introduction and Objectives: This study investigated the impact of extra-retroperitoneal (ERP) residual masses (RM) on progression and survival in patients (pts) submitted to postchemotherapy (PCT) retroperitoneal lymphadenectomy (RPLA) in advanced nonseminomatous testicular tumors (NSTT). Material and Methods: 188 pts underwent PCT RPLA, with 30 pts submitted to ERP resection. In total, 44 ERP resections were performed including pulmonary (24), cervical LN (6), liver (3), mediastinal LN (5) and brain site (3) with nephrectomy in 3 pts (74 asynchronous surgical procedures). Results: All 30 pts with ERP RM underwent PCT-RPLA (incomplete in 3 pts) with finding of fibrosis (F) in 37%, teratoma (T) in 43% and vital carcinoma (VC) in 20% pts (5 redo-op, 4 RPLN, 1 mediastinal LN, discordant histology in 1 pt). Overall, 21 pts (70%) had ERP specimen with the same histology as on RPLA. At median follow-up of 98 months, overall relapse rate was 27% with survival in 79% pts. Among 158 pts submitted to PCT-RPLA histology indicated F in 27%, T in 52% and VC in 21% pts (19 redo-RPLA, 7 discordant histology). Overall RP histology demonstrated the presence of F in 29%, T in 50% and VC in 21% pts. The presence of RM in the ERP group was associated with higher progression (30 %) and lower survival
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(60 %) (p < 0.0001) (95% CI, 3.2657–18.529) vs RM in the RP (18% and 82%) (p < 0.063) (95% CI, 1.3405–7.147). The pts with residual ERP F/T vs VC are at higher risk of progression (46% vs 67%) and worse survival (67% vs 33%) (p < 0.0006) (95% CI, 1.469–17.15) compared to those with disease confined to RP (14% vs 33%) and (89% vs 58%), respectively (p < 0.02) (95% CI, 10.632–25.318). Factors predicting the worse prognosis included a RP RM >5 cm (p < 0.0018), IGCCCG risk classification (p < 0.004), completeness of PCT-RPLA (p < 0.0001), redo-RPLA (p < 0.007), ERP surgery (p < 0.006), elevated STM (p < 0.0001) and VC either in the RP (p < 0.0001) or ERP site (p = 0.00015). Conclusions: Despite the high concordance between the histology of RP and ERP RM, every effort should be made to remove all RM, whatever it localization. S54 Management and outcome of bilateral testicular germ cell tumors in the past decade: experience from large single cancer center N. Bojanic *, D. Nale, A. Janjic, I. Vukovic, A. Vuksanovic, S. Micic. Clinical Center of Serbia, Clinic of Urology, Belgrade, Serbia Introduction and Objectives: We analyzed the testis sparing surgery (TSS) and outcome of our pts with bilateral testicular germ cell tumor (TGCT). Material and Methods: From 1999 to 2009, 586 pts with testicular cancer were treated. A total of 18 pts with bilateral TGCT were identified. The clinical records of these were reviewed for age, histology of the 2 tumors, stage at presentation of the first and second tumor, interval between tumors, treatment and clinical outcome. Results: Metachronous was identified in 14 pts and synchronous bilateral TGCT in 4 pts. In the group of synchronous bilateral TGCT, 2 pts were with seminoma (respectively stage I and stage III), one NSGCTT (stage I) and one was with NSGCTT in one and Leydigeoma in the other testicle (stage I). Seven pts metachronous group were with NSGCTT (6 pts: stage I and 1: stage III), 3 seminoma (stage I), 2 pts had seminoma-NSGCCT histology (one stage I and one stage III) and 2 NSGCTT-seminoma histology (both: stage I). All pts received chemotherapy following the initial treatment (radical orchiectomy or TSS) and only 5 out of 14 pts in metachronous bilateral TGCT due to stage III (2 pts), high risk NSGCTT stage I (2 pts) and one progression to retroperitoneum. TSS was performed in 2 out of 4 pts with synchronous bilateral TGCT – patient with NSGCTT in both testicles and the other one with NSGCTT and Leydigeoma, and in 7 out of 14 pts with metachronous bilateral TGCT – 2 in pts with seminoma following seminoma, 4 in pts with NSGCTT following NSGCTT and in one seminoma following NSGCTT. In three cases a new tumor was detected by ultrasound, in the testicle following TSS – 5, 8 and 65 months; radical orchiectomy was done in both cases. Median age of pts with metachronous testicular cancer was 31.7 years and 34.2 years at first and second tumor diagnosis. Median follow-up time was 62 months (4–124 months) and the 5-year overall survival was 94%. In metachronous bilateral TGCT, the interval between the tumors: 5 months–20 years, with a median of 44 months (1 patient with interval of 20 yrs tumor’s interval was excluded from statistical analysis). One patient died due to progression of disease 10 months following the second radical orchiectomy and chemotherapy. Conclusions: Despite the fact that both synchronous and metachronous bilateral TGCT carry a similar, excellent prognosis, pts with unilateral TGCT require careful long-term monitoring of the remaining testicle due to increased risk of contralateral disease and a potentially long risk interval of about 20 yrs.
eau 5th south eastern european meeting (seem) / european urology supplements 8 (2009) 607–655
Conclusions: We consider that in children the overactive bladder is a common condition, characterized by sharp decrease of the quality of life and social adaptation, and because of it its treatment is obligatory. According to us the main method of diagnosis and follow up is the non-invasive urodynamics, and medication is main treatment of choice.
Poster Session 4: Testicular cancer, infertility, erectile dysfunction Friday, 9 October 2009, 15:20–17:30 Room 1 S50 Frequency of retroperitoneal metastasis and comparison of pathohistological findings of primary testicular tumor and retroperitoneal metastasis S. Zivojinov1 *, M. Zivojinov2 , N. Dejanovic3 , S. Vojinov3 , G. Marusic3 , D. Jeremic3 . 1 Clinical Center Vojvodina, Department of Urology, Novi Sad, Serbia; 2 Clinical Center Vojvodina, Dept. of Pathology, Novi Sad, Serbia; 3 Clinical Center Vojvodina, Dept. of Urology, Novi Sad, Serbia Introduction and Objectives: Objective is to compare pathohistological finding of testicular tumor with type of metastasis in retroperitoneal lymph nodes, when is well known that these tumors bring lymphogenic metastasis first. Because these tumors originated of totipotent cells, pathohistological finding of primary tumor and metastasis can be significantly different. Material and Methods: In period of 2004–2009, in Department of Urology, Clinical Center Vojvodina was performed 48 retroperitoneal lymphadenectomy. In that number, there were 25 bilateral and 20 unilateral, and last 3 was reoperation of suspicious relapse after previous lymphadenectomy. Diagnostic algorithm comprise: determination of tumor markers before and after inguinal orchiectomy, pathohistological finding of primary tumor, CT scans of abdomen and pelvis, and in selective cases also CT scan of lungs. After that, multidiscipline team selects therapy (watchful waiting, chemotherapy, surgery – retroperitoneal lymphadenctomy, radiotherapy) Results: Most common primary tumor was seminoma, embryonal carcinoma and mixed tumors (with several pathohistologic types). Retroperitoneal metastasis was discovering in 19 of 48 patients (39.58%). The same pathohistological finding in metastasis as well in primary tumor was discovering in 78.95% patients. In one patient, in which case was perform relymphadenectomy, type of malignant tumor was not precise defined, and in last 3 patients was discovered teratoma although primary tumor was embryonal carcinoma. In 3 patients with mixed primary tumor, metastasis contained only one pathohistological type, and that one was less present component in primary tumor. In 16 patients in which weren’t discovered tumor, exist focuses of necrosis and chronic reactive lymphadenitis. Conclusions: Significant number of patients has retroperitoneal metastasis. Also, great number of patients has focuses of necrosis in removed retroperitoneal lymph nodes. In most patients with metastasis, tumor in metastasis was the same one as in primary testicular tumor. Only in one case, when relymphadenectomy was performed, pathohistological type of tumor wasn’t precise diagnosed with standard pathohistological analysis.
S51 Management of clinical stage A, B1 and B2 with nonseminomatous testicular tumors avoiding upfront retroperitoneal lymphadenectomy D. Argirovic1 *, A. Argirovic2 . 1 Clinic of Urology, Outpatient Clinic Argirovic, Urology, Belgrade, Serbia; 2 Kbc Zemun, Urology, Belgrade, Serbia Introduction and Objectives: Patients (pts) in clinical stage (CS) A, B1 and B2 nonseminomatous testicular tumors (NSTT) may be treated by either retroperitoneal lymphadenectomy (RPLA) + chemotherapy (CT) in selected cases or with primary cisplatin (CDDP)-based CT followed by surgery in pts with residual disease (ds). Material and Methods: We treated between 1980 and 2005 in the prospective but non-randomized study 650 pts in low CS NSTT. The pts are divided into 2 groups according to primary treatment: Arm A (n = 170) managed with RPLA ± CT and Arm B (n = 480) with primary CDDP-based CT ± surgery. Results: 24 pts with low risk (LR) (<50% EC, no VI) in Arm A had universal survival at median follow-up (MFU) of 16.6 years (y) with 2 pts (8%) with LN metastasis necessitating CT vs 6/40 pts (15%) relapsing on surveillance who achieved CR with CT alone at MFU of 13.5 y (p < 0.042). In high risk group (>50% EC, VI+) relapse rate (RR) occurred in 10/60 pts (17%) in Arm A vs 2/78 (3%) managed with 2 cycles of CT following orhiectomy (p < 0.0036) necessitating salvage CT + lung surgery (vital GCT 2) in Arm B, with DSS in 93% and 99% (p < 0.0416), at MFU of 14.5 and 8.5 y, respectively. In Arm A, 21 pts (35%) necessitate CT post-RPLA (7 in PS-A due to relapse and 14 due to LN metastasis) (p < 0.0013) without difference in RR (14% vs 21%) (p = 0.585). Overall in pts with persistently elevated STM post-orchiectomy there was lower occurrence of RR (33% vs 9%) (p < 0.0094) in favor of Arm B but DSS did not differ significantly (95% vs 97%) (p = 0.660) at MFU of 15.8 and 15.6 y, respectively. In Arm B, 13 pts (7%) necessitated RPLA due to progression (fibrosis 15%, teratoma 62%, vital GCT 23%) (favorable histology had universal DSS vs no survival with vital GCT). Overall in CS B1/B2, RR was 14 vs 8% (P = 0.1774) and DSS in 90% vs 96% (P = 0.395), at MFU of 18.3 and 12.9 y, respectively. In Arm A, CS B1 vs B2 were characterized with RR of 5% vs 24% (p = 0.779) and DSS in 100% vs 81% (p < 0.055) at MFU of 17.4 and 19.1 y, respectively. In arm B PCT-RPLA was indicated in 40 pts (12%) (fibrosis 22%, teratoma 61%, Vital GCT 17%). Favorable vs worse histology occurred in relation of 83% vs 17% (p < 0.001) and predicted unfavorable DSS (100% vs 43%) (p < 0.0001). Analysis of 480 pts in Arm A, managed with surveillance in LR CS-A NSTT and primary CT ± surgery in the remaining 440 pts, demonstrated low RR (8%), excellent DSS (98%), whereas surgery was indicated in only 11% pts. Statistical analysis failed to demonstrate significant difference regarding RR and DSS between Arm A and B, except the need for adjuvant therapy (CT vs surgery) (55% vs 11%) (p < 0.00001). Conclusions: Primary CT is feasible mode of treatment in pts with low CS NSTT without substantially increasing the proportion of pts exposed to surgery. S52 Pathologic findings and clinical outcome of patients undergoing retroperitoneal lymphadenectomy after multiple chemotherapy regimens for metastatic nonseminomatous testicular tumors D. Argirovic1 *, V. Stanic2 , A. Argirovic3 . 1 Clinic of Urology, Outpatient Clinic Argirovic, Urology, Belgrade, Serbia; 2 Military Medical Academy, Thoracic Surgery, Belgrade, Serbia; 3 Kbc Zemun, Urology, Belgrade, Serbia Introduction and Objectives: We reviewed our experience with retroperitoneal lymphadenectomy (RPLA) after multiple
eau 5th south eastern european meeting (seem) / european urology supplements 8 (2009) 607–655
cisplatin (CDDP)-based chemotherapy (CT) regimens in nonseminomatous testicular tumors (NSTT) patients (pts) and specifically evaluated clinic-pathologic and treatment trend in addition to potential predictors of survival. Material and Methods: 41 pts with NSTT underwent their RPLA between 1980 and 2005 after >2 regimens of CT. 13 pts (32%) necessitate redo-RPLA, combined with nephrectomy in pts. 13 extra-RP resections were performed in 11 pts (27%), including pulmonary (7), neck (4) and liver (2) sites. Results: 30 pts (73%) are rendered grossly free of disease (ds) and 26 (63%) obtained serologic remission. 9 pts who relapsed within MFI of 28 months (m) (RPLN 8, RPLN+lung 1) necessitated CT+surgery (3 teratoma, 6 vital GCT). 4/9 relapsing pts (44%) are currently free of ds with redo-RPLA. Alive, free of ds are 19 pts (46%) at MFU of 131 m. Study of RP pathology demonstrated the presence of fibrosis in 15%, teratoma in 39% and vital GCT in 46%, with survival in 67%, 56%, and 32%, respectively. Worse vs favourable histology occurred in relation of 32% vs 59% (p < 0.05). Different histology occurred in 38% at redo-RPLA and in 64% at ERP resection in comparison to previous RP pathology (p = 0.219). Univariate analysis of clinicopathologic parameters associated with vital GCT at RPLA included RP mass >5 cm (p < 0.05), elevated AFP (p < 0.001) or HCG (p < 0.05) and ERP resection (p < 0.04). On univariate analysis survival was worse in pts with RP masses >5 cm (p < 0.04), elevated AFP (p < 0.05) or HCG (p < 0.007), ERP resection (p < 0.01), and vital GCT (p < 0.004). On multivariable analysis, a RP mass >5 cm (p < 0.03) and vital GCT (p < 0.005) predicted a worse prognosis. Vital GCT either in the RP or in ERP sites predicted worse prognosis (p = 0.001). Conclusions: Our data support the continued use of salvage RPLA in 3 separated groups of pts: 1. Pts who achieved a CR on 2nd line CT and have no radiologic evidence of ds should undergo RPLA; 2. Pts who achieved a PR to CT should undergo RPLA with ERP surgery, as indicated; 3. Highly selected pts with residual mass and elevated STM, particularly AFP, after CT may be candidates for surgery. S53 The impact of residual extra-retroperitoneal masses in patients with advanced nonseminomatous testicular tumors D. Argirovic1 *, V. Stanic2 , A. Argirovic3 . 1 Clinic of Urology, Outpatient Clinic Argirovic, Urology, Belgrade, Serbia; 2 Military Medical Academy, Thoracic Surgery, Belgrade, Serbia; 3 Kbc Zemun, Urology, Belgrade, Serbia Introduction and Objectives: This study investigated the impact of extra-retroperitoneal (ERP) residual masses (RM) on progression and survival in patients (pts) submitted to postchemotherapy (PCT) retroperitoneal lymphadenectomy (RPLA) in advanced nonseminomatous testicular tumors (NSTT). Material and Methods: 188 pts underwent PCT RPLA, with 30 pts submitted to ERP resection. In total, 44 ERP resections were performed including pulmonary (24), cervical LN (6), liver (3), mediastinal LN (5) and brain site (3) with nephrectomy in 3 pts (74 asynchronous surgical procedures). Results: All 30 pts with ERP RM underwent PCT-RPLA (incomplete in 3 pts) with finding of fibrosis (F) in 37%, teratoma (T) in 43% and vital carcinoma (VC) in 20% pts (5 redo-op, 4 RPLN, 1 mediastinal LN, discordant histology in 1 pt). Overall, 21 pts (70%) had ERP specimen with the same histology as on RPLA. At median follow-up of 98 months, overall relapse rate was 27% with survival in 79% pts. Among 158 pts submitted to PCT-RPLA histology indicated F in 27%, T in 52% and VC in 21% pts (19 redo-RPLA, 7 discordant histology). Overall RP histology demonstrated the presence of F in 29%, T in 50% and VC in 21% pts. The presence of RM in the ERP group was associated with higher progression (30 %) and lower survival
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(60 %) (p < 0.0001) (95% CI, 3.2657–18.529) vs RM in the RP (18% and 82%) (p < 0.063) (95% CI, 1.3405–7.147). The pts with residual ERP F/T vs VC are at higher risk of progression (46% vs 67%) and worse survival (67% vs 33%) (p < 0.0006) (95% CI, 1.469–17.15) compared to those with disease confined to RP (14% vs 33%) and (89% vs 58%), respectively (p < 0.02) (95% CI, 10.632–25.318). Factors predicting the worse prognosis included a RP RM >5 cm (p < 0.0018), IGCCCG risk classification (p < 0.004), completeness of PCT-RPLA (p < 0.0001), redo-RPLA (p < 0.007), ERP surgery (p < 0.006), elevated STM (p < 0.0001) and VC either in the RP (p < 0.0001) or ERP site (p = 0.00015). Conclusions: Despite the high concordance between the histology of RP and ERP RM, every effort should be made to remove all RM, whatever it localization. S54 Management and outcome of bilateral testicular germ cell tumors in the past decade: experience from large single cancer center N. Bojanic *, D. Nale, A. Janjic, I. Vukovic, A. Vuksanovic, S. Micic. Clinical Center of Serbia, Clinic of Urology, Belgrade, Serbia Introduction and Objectives: We analyzed the testis sparing surgery (TSS) and outcome of our pts with bilateral testicular germ cell tumor (TGCT). Material and Methods: From 1999 to 2009, 586 pts with testicular cancer were treated. A total of 18 pts with bilateral TGCT were identified. The clinical records of these were reviewed for age, histology of the 2 tumors, stage at presentation of the first and second tumor, interval between tumors, treatment and clinical outcome. Results: Metachronous was identified in 14 pts and synchronous bilateral TGCT in 4 pts. In the group of synchronous bilateral TGCT, 2 pts were with seminoma (respectively stage I and stage III), one NSGCTT (stage I) and one was with NSGCTT in one and Leydigeoma in the other testicle (stage I). Seven pts metachronous group were with NSGCTT (6 pts: stage I and 1: stage III), 3 seminoma (stage I), 2 pts had seminoma-NSGCCT histology (one stage I and one stage III) and 2 NSGCTT-seminoma histology (both: stage I). All pts received chemotherapy following the initial treatment (radical orchiectomy or TSS) and only 5 out of 14 pts in metachronous bilateral TGCT due to stage III (2 pts), high risk NSGCTT stage I (2 pts) and one progression to retroperitoneum. TSS was performed in 2 out of 4 pts with synchronous bilateral TGCT – patient with NSGCTT in both testicles and the other one with NSGCTT and Leydigeoma, and in 7 out of 14 pts with metachronous bilateral TGCT – 2 in pts with seminoma following seminoma, 4 in pts with NSGCTT following NSGCTT and in one seminoma following NSGCTT. In three cases a new tumor was detected by ultrasound, in the testicle following TSS – 5, 8 and 65 months; radical orchiectomy was done in both cases. Median age of pts with metachronous testicular cancer was 31.7 years and 34.2 years at first and second tumor diagnosis. Median follow-up time was 62 months (4–124 months) and the 5-year overall survival was 94%. In metachronous bilateral TGCT, the interval between the tumors: 5 months–20 years, with a median of 44 months (1 patient with interval of 20 yrs tumor’s interval was excluded from statistical analysis). One patient died due to progression of disease 10 months following the second radical orchiectomy and chemotherapy. Conclusions: Despite the fact that both synchronous and metachronous bilateral TGCT carry a similar, excellent prognosis, pts with unilateral TGCT require careful long-term monitoring of the remaining testicle due to increased risk of contralateral disease and a potentially long risk interval of about 20 yrs.