MP10-09 CONTEMPORARY USE OF RETROPERITONEAL LYMPH NODE DISSECTION FOR STAGE II NON-SEMINOMATOUS GERM CELL TUMOR: A POPULATION-BASED STUDY USING SURVEILLANCE EPIDEMIOLOGY AND END RESULTS

Abstract

You have accessJournal of UrologySexual Function/Dysfunction/Andrology: Penis/Testis/Urethra: Malignant Disease1 Apr 2015MP10-09 CONTEMPORARY USE OF RETROPERITONEAL LYMPH NODE DISSECTION FOR STAGE II NON-SEMINOMATOUS GERM CELL TUMOR: A POPULATION-BASED STUDY USING SURVEILLANCE EPIDEMIOLOGY AND END RESULTS Eugene Pietzak, Jeremy Bonzo, S. Bruce Malkowicz, Alan Wein, and Thomas Guzzo Eugene PietzakEugene Pietzak More articles by this author , Jeremy BonzoJeremy Bonzo More articles by this author , S. Bruce MalkowiczS. Bruce Malkowicz More articles by this author , Alan WeinAlan Wein More articles by this author , and Thomas GuzzoThomas Guzzo More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2015.02.410AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES The use of primary Retroperitoneal Lymph Node Dissection (RPLND) for clinical stage I Non-Seminomatous Germ Cell Tumor (NSGCT) has decreased over the last several years; however little is known about the use of primary RPLND in the setting of clinical stage II NSGCT. METHODS We identified patients within the Surveillance, Epidemiology, and End Results (SEER) 18 region dataset from 2004 to 2011 diagnosed with stage II (T 1–4 N 1–3 M 0) NSGCT. We stratified patients into two groups by whether or not they were initially managed with RPLND at the time of diagnosis. We compared these groups for variables associated with undergoing RPLND, as well as for differences in survival outcomes. RESULTS Of 1,259 patients with stage II NSGCT, 636 (50.5%) underwent an initial RPLND. RPLND was not associated with age, race, ethnicity, year of diagnosis, month of diagnosis, marital status, insurance status, or primary tumor stage. Only the presence of teratoma in the orchiectomy specimen and receiving treatment in the northeast United States was positively associated with undergoing RPLND (p<0.001). There were 160 patients with bulky lymph nodes ≥5 cm at diagnosis, of which 90 (56.3%) underwent an initial RPLND. Furthermore, 46.9% of patients with an elevated post-orchiectomy Beta-HCG and 51% with an elevated post-orchiectomy AFP underwent an initial RPLND. The rate of initial RPLND in the setting of bulky lymph nodes and elevated tumor markers remained constant even in the most recent years (p=0.1). For patients with lymph nodes <2 cm (stage IIA T1-4 N1 M0), the five-year cancer specific survival (CSS) was 99.3% for initial RPLND and 95.8% for those not initially managed with RPLND. For patients with bulky lymph nodes ≥5 cm (stage IIC T1-4 N3 M0), the five-year CSS was 95.6% for initial RPLND and 93.1% if not initially managed with RPLND. CONCLUSIONS RPLND offers many benefits for patients with stage IIA NSGCT, including the potential reduction or avoidance of chemotherapy. However, our analysis raises concerns that many patients with bulky lymph nodes and elevated post-orchiectomy tumor markers may also be undergoing primary RPLND. This may result in an increased need for “double therapy” with subsequent chemotherapy. © 2015 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 193Issue 4SApril 2015Page: e114 Advertisement Copyright & Permissions© 2015 by American Urological Association Education and Research, Inc.MetricsAuthor Information Eugene Pietzak More articles by this author Jeremy Bonzo More articles by this author S. Bruce Malkowicz More articles by this author Alan Wein More articles by this author Thomas Guzzo More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...