Portal de Periódicos da CAPES

Predictors of Positive Retroperitoneal Lymph Nodes in Patients With High Risk Testicular Cancer

2011; Lippincott Williams & Wilkins; Volume: 186; Issue: 6 Linguagem: Inglês

10.1016/j.juro.2011.07.101

1527-3792

Stephen B. Williams, Ravi Kacker, Winston Dock, Eamonn Bahnson, Graeme S. Steele, John P. Richie,

Urologic and reproductive health conditions

No AccessJournal of UrologyAdult Urology1 Dec 2011Predictors of Positive Retroperitoneal Lymph Nodes in Patients With High Risk Testicular Cancer S.B. Williams, R. Kacker, D. Winston, E. Bahnson, G.S. Steele, and J.P. Richie S.B. WilliamsS.B. Williams , R. KackerR. Kacker , D. WinstonD. Winston , E. BahnsonE. Bahnson , G.S. SteeleG.S. Steele , and J.P. RichieJ.P. Richie View All Author Informationhttps://doi.org/10.1016/j.juro.2011.07.101AboutFull TextPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract Purpose: Percent of embryonal carcinoma and lymphovascular invasion in the primary tumor are risk factors for occult retroperitoneal metastatic disease. High risk patients with clinical stage I and IIA nonseminomatous germ cell tumor who underwent primary retroperitoneal lymph node dissection were identified to discern any other risk factors for metastatic disease. Materials and Methods: Patients who had undergone retroperitoneal lymph node dissection at our institution from 1993 to 2009 were identified and clinical charts were reviewed. A total of 90 patients with orchiectomy specimens containing more than 30% embryonal carcinoma who underwent primary retroperitoneal lymph node dissection were identified and perioperative data were obtained. Results: Of 353 patients 90 (25%) had greater than 30% embryonal carcinoma and underwent primary retroperitoneal lymph node dissection. Of these patients 45 (50%) had lymphovascular invasion. Median followup was 1.1 years. Positive lymph nodes identified at retroperitoneal lymph node dissection were noted in 30 (46%) and 15 (60%) patients with clinical stage I vs clinical stage II disease. On multivariate analysis embryonal carcinoma (OR 1.02, 95% CI 1.00–1.04) and lymphovascular invasion (OR 3.52, 95% CI 1.43–8.67) were associated with positive lymph nodes at retroperitoneal lymph node dissection. The positive predictive value for 100% embryonal carcinoma was 65.5%, although the negative predictive value for 30% embryonal carcinoma was 85.7%. Conclusions: Embryonal carcinoma and lymphovascular invasion were significantly and independently associated with the risk of occult retroperitoneal metastatic disease. These results should be considered when counseling patients about appropriate treatment options. References 1 : Retroperitoneal lymph node dissection for nonseminomatous germ cell testicular cancer: impact of patient selection factors on outcome. J Clin Oncol2005; 23: 2781. Google Scholar 2 : Long-term neurologic and peripheral vascular toxicity after chemotherapy treatment of testicular cancer. Cancer2010; 116: 2322. Google Scholar 3 : Treatment-specific risks of second malignancies and cardiovascular disease in 5-year survivors of testicular cancer. J Clin Oncol2007; 25: 4370. Google Scholar 4 : Computed tomography–an increasing source of radiation exposure. N Engl J Med2007; 357: 2277. Google Scholar 5 : Short-term morbidity of primary retroperitoneal lymph node dissection in a contemporary group of patients. J Urol2007; 178: 504. Link, Google Scholar 6 : Morbidity of open retroperitoneal lymph node dissection for testicular cancer: contemporary perioperative data. BJU Int2010; 105: 918. Google Scholar 7 : Prognostic risk factors that identify patients with clinical stage I nonseminomatous germ cell tumors at low risk and high risk for metastasis. Cancer1998; 83: 1002. Google Scholar 8 : Results and outcome of retroperitoneal lymph node dissection for clinical stage I embryonal carcinoma–predominant testis cancer. J Clin Oncol2000; 18: 358. Google Scholar 9 : Risk factors for relapse in clinical stage I nonseminomatous testicular germ cell tumors: results of the German Testicular Cancer Study Group Trial. J Clin Oncol2003; 21: 1505. Google Scholar 10 : Prognosis and other clinical correlates of pathologic review in stage I and II testicular carcinoma: a report from the Testicular Cancer Intergroup Study. J Clin Oncol1992; 10: 69. Google Scholar 11 : Minimizing treatment without compromising cure with primary surveillance for clinical stage I embryonal predominant nonseminomatous testicular cancer: a population based analysis from British Columbia. J Urol2005; 174: 2209. Link, Google Scholar 12 : Retroperitoneal lymph node dissection in patients with high risk testicular cancer. J Urol2009; 181: 2097. Link, Google Scholar 13 : Cardiovascular disease as a long-term complication of treatment for testicular cancer. J Clin Oncol2003; 21: 1513. Google Scholar 14 : Pulmonary function in long-term survivors of testicular cancer. J Clin Oncol2009; 27: 2779. Google Scholar 15 : Retroperitoneal lymph node dissection in patients with low stage testicular cancer with embryonal carcinoma predominance and/or lymphovascular invasion. J Urol2005; 174: 557. Link, Google Scholar 16 : European consensus on diagnosis and treatment of germ cell cancer: a report of the European Germ Cell Cancer Consensus Group (EGCCCG). Ann Oncol2004; 15: 1377. Google Scholar 17 : Long-term results following adjuvant chemotherapy in patients with clinical stage I testicular nonseminomatous malignant germ cell tumors with high risk factors. J Urol1999; 161: 1148. Link, Google Scholar 18 : Nonrandomized comparison of primary chemotherapy and retroperitoneal lymph node dissection for clinical stage IIA and IIB nonseminomatous germ cell testicular cancer. J Clin Oncol2007; 25: 5597. Google Scholar 19 : Quality of surveillance for stage I testis cancer in the community. J Clin Oncol2009; 27: 4327. Google Scholar 20 : Non-risk-adapted surveillance in clinical stage I nonseminomatous germ cell tumors: the Princess Margaret Hospital's experience. Eur Urol2011; 59: 556. Google Scholar 21 : Retroperitoneal lymphadenectomy for clinical stage A testis cancer (1965 to 1989): modifications of technique and impact on ejaculation. J Urol1993; 149: 237. Link, Google Scholar Division of Urology, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts© 2011 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 186Issue 6December 2011Page: 2245-2248 Advertisement Copyright & Permissions© 2011 by American Urological Association Education and Research, Inc.Keywordslymph node excisiontesticular neoplasmscarcinomaembryonalMetricsAuthor Information S.B. Williams More articles by this author R. Kacker More articles by this author D. Winston More articles by this author E. Bahnson More articles by this author G.S. Steele More articles by this author J.P. Richie More articles by this author Expand All Advertisement PDF downloadLoading ...