829 RATES OF TERATOMA AT POST-CHEMOTHERAPY RETROPERITONEAL LYMPH NODE DISSECTION BY INDUCTION CHEMOTHERAPY REGIMEN FOR GOOD RISK NON-SEMINOMATOUS GERM CELL TUMORS

Abstract

You have accessJournal of UrologyPenis/Testis/Urethra: Benign & Malignant Disease1 Apr 2011829 RATES OF TERATOMA AT POST-CHEMOTHERAPY RETROPERITONEAL LYMPH NODE DISSECTION BY INDUCTION CHEMOTHERAPY REGIMEN FOR GOOD RISK NON-SEMINOMATOUS GERM CELL TUMORS Shilajit Kundu, Brett Carver, Dean Bajorin, Robert Motzer, George Bosl, Darren Feldman, and Joel Sheinfeld Shilajit KunduShilajit Kundu Chicago, IL More articles by this author , Brett CarverBrett Carver New York, NY More articles by this author , Dean BajorinDean Bajorin New York, NY More articles by this author , Robert MotzerRobert Motzer New York, NY More articles by this author , George BoslGeorge Bosl New York, NY More articles by this author , Darren FeldmanDarren Feldman New York, NY More articles by this author , and Joel SheinfeldJoel Sheinfeld New York, NY More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2011.02.649AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Standard of care for patients with good risk IGCCCG NSGCT is induction chemotherapy with either 4 cycles of etoposide and platinum (EP) or three cycles of bleomycin, etoposide, and platinum (BEP). Rates of teratoma at post-chemotherapy retroperitoneal lymph node dissection (PC-RPLND) have differed between centers which treat a high volume of testicular cancer where treatment regimens vary for good risk NSGCT. We hypothesize that induction chemotherapy regimen may be play a role in this phenomenon. METHODS From 1989 to 2009, 579 patients were treated with induction chemotherapy for good risk NSGCT followed by PC-RPLND. Five-hundred five patients were treated with EP and 74 patients were treated with BEP. Clinical and pathologic features of the groups at orchiectomy and PC-RPLND are reported. Categorical variables were compared using the chi-square. Logistic regression was used for both univariate and multivariate analyses to assess factors that were associated with the presence of teratoma. Twenty-eight patients received 4 cycles of BEP at outside institutions. Separate analyses were performed excluding these patients. Survival analysis was performed using the Kaplan-Meier method, and comparisons were made using the log-rank test. RESULTS Teratoma was more prevalent in the BEP group vs. EP (57% vs. 34%, respectively, p<0.001) at PC-RPLND. On multivariate analysis, patients that received BEP vs. EP were at a 2-fold increased risk of harboring teratoma at the time of PC-RPLND (OR 2.0, 95% CI 1.0, 4.0, p=0.04) even when accounting for other variables. When excluding patients that received 4 cycles of BEP, patients that received BEP x 3 were still at a 3.7 fold increased risk of having teratoma in the retroperitoneum (OR 3.7, 95% CI 1.5, 8.9, p=0.004). In the cohort of patients with residual post-chemotherapy lymph nodes ≤ 1 cm, patients that received BEP vs. EP were at a 4.6 fold increased risk of harboring teratoma at the time of PC-RPLND (OR 4.6, (95% CI 1, 17), p=0.03) and this held true when excluding patients that received 4 cycles of BEP with post-chemotherapy lymph nodes ≤ 1 cm. (OR 10.3, (95% CI 1.8, 59), p=0.008). Relapse free survival and disease specific survival was not different between these patients. CONCLUSIONS Patients that received BEP were more likely to harbor teratoma in the retroperitoneum compared to patients that received EP as part of an induction chemotherapy regimen. This remained true for all patients including patients with post-chemotherapy lymph nodes ≤ 1cm. © 2011 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 185Issue 4SApril 2011Page: e334 Peer Review Report Advertisement Copyright & Permissions© 2011 by American Urological Association Education and Research, Inc.MetricsAuthor Information Shilajit Kundu Chicago, IL More articles by this author Brett Carver New York, NY More articles by this author Dean Bajorin New York, NY More articles by this author Robert Motzer New York, NY More articles by this author George Bosl New York, NY More articles by this author Darren Feldman New York, NY More articles by this author Joel Sheinfeld New York, NY More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...