562 OUTCOMES IN PATIENTS WITH VIABLE CANCER AT POST-CHEMOTHERAPY RETROPERITONEAL LYMPH NODE DISSECTION

Abstract

You have accessJournal of UrologyPenis/Testis/Urethra: Benign & Malignant Disease I1 Apr 2010562 OUTCOMES IN PATIENTS WITH VIABLE CANCER AT POST-CHEMOTHERAPY RETROPERITONEAL LYMPH NODE DISSECTION Shilajit Kundu, Brett Carver, Nicholas Karanikolas, George Bosl, Robert Motzer, Dean Bajorin, Darren Feldman, and Joel Sheinfeld Shilajit KunduShilajit Kundu More articles by this author , Brett CarverBrett Carver More articles by this author , Nicholas KaranikolasNicholas Karanikolas More articles by this author , George BoslGeorge Bosl More articles by this author , Robert MotzerRobert Motzer More articles by this author , Dean BajorinDean Bajorin More articles by this author , Darren FeldmanDarren Feldman More articles by this author , and Joel SheinfeldJoel Sheinfeld More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2010.02.808AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Risk stratification for patients with advanced disease, completeness of surgery, and improved chemotherapy regimens have resulted in a decrease in the incidence of viable germ cell tumor in resected retroperitoneal specimens. We report on the incidence and clinical outcomes of patients treated with post-chemotherapy lymph node dissection that had residual viable GCT in the retroperitoneum. METHODS From 1989 to 2009, 985 patients with advanced NSGCT were treated with induction and/or salvage chemotherapy followed by PC-RPLND. Following institutional review board approval, complete clinical and pathologic data were obtained from our prospective surgical database. Ninety patients were found to have viable GCT at RPLND. Clinical and pathologic features of patients with viable 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. New York, NY© 2010 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 183Issue 4SApril 2010Page: e220-e221 Peer Review Report Advertisement Copyright & Permissions© 2010 by American Urological Association Education and Research, Inc.MetricsAuthor Information Shilajit Kundu More articles by this author Brett Carver More articles by this author Nicholas Karanikolas More articles by this author George Bosl More articles by this author Robert Motzer More articles by this author Dean Bajorin More articles by this author Darren Feldman More articles by this author Joel Sheinfeld More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...