PD53-02 ONCOLOGIC EFFICACY OF PRIMARY RETROPERITONEAL LYMPH NODE DISSECTION FOR PATIENTS WITH PATHOLOGIC N1, N2, AND N3 DISEASE

Abstract

You have accessJournal of UrologyPenile & Testicular Cancer: Penile & Testicular Cancer II (PD53)1 Sep 2021PD53-02 ONCOLOGIC EFFICACY OF PRIMARY RETROPERITONEAL LYMPH NODE DISSECTION FOR PATIENTS WITH PATHOLOGIC N1, N2, AND N3 DISEASE Sean Kern, Isamu Tachibana, Mohammad Mahmoud, Timothy Masterson, Nabil Adra, Richard Foster, Lawrence Einhorn, and Clint Cary Sean KernSean Kern More articles by this author , Isamu TachibanaIsamu Tachibana More articles by this author , Mohammad MahmoudMohammad Mahmoud More articles by this author , Timothy MastersonTimothy Masterson More articles by this author , Nabil AdraNabil Adra More articles by this author , Richard FosterRichard Foster More articles by this author , Lawrence EinhornLawrence Einhorn More articles by this author , and Clint CaryClint Cary More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000002080.02AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Adjuvant chemotherapy (AC) has been advocated after primary retroperitoneal lymph node dissection (RPLND) to reduce the historical 50% risk of relapse in pN2/N3 patients, whereas surveillance is preferred for pN1 patients. We sought to explore the oncologic efficacy of primary RPLND alone in non-seminomatous germ cell tumors in an effort to reduce overtreatment with chemotherapy. METHODS: Patients with pathologic stage II germ cell tumor after primary RPLND between 2007-2017 were identified. Patients were excluded for elevated pre-operative serum tumor markers, receipt of adjuvant chemotherapy, or if pure teratoma or primitive neuro-ectodermal tumor elements were found in the retroperitoneum on pathology. RESULTS: We identified 106 patients to have active germ cell tumor in the retroperitoneum following primary RPLND. Fourteen patients received AC and were excluded from the analysis. There were 56.2% of patients with predominant (>50%) embryonal carcinoma in the orchiectomy specimen and 51% had lymphovascular invasion. Median follow up of the entire cohort was 51.5 months. There were 92 patients treated with RPLND alone of which 39 were pN1, 43 were pN2, and 10 were pN3. Seventy four of the 92 patients have not recurred; their pathologic N stages were 30 pN1, 37 pN2, and 7 pN3. The 5-year recurrence-free survival by pN stage was 85% pN1, 85% pN2, and 63% pN3, respectively (log-rank p-value 0.56, Fig 1). All 18 patients who recurred were treated with first line chemotherapy (usually BEPx3) and remain continuously disease free. Locations of recurrence include biochemical (2), pelvis (2), lung (5), mediastinum (1), suprahilar (1), contralateral/out of field (2), in-field (1 bilateral, 1 right modified, 1 left modified template). Additionally, 2 patients had simultaneous recurrences in the lung/suprahilar region and lung/contralateral retroperitoneum, respectively. No patient died of testicular cancer. CONCLUSIONS: The majority (80.5%) of men with pathologic stage II disease treated with surgery alone in our series never experienced a recurrence. Furthermore, we did not observe a difference in recurrences between pN1 and pN2 patients and thus recommending adjuvant chemotherapy for N2 disease may result in overtreatment in the majority. Source of Funding: None © 2021 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 206Issue Supplement 3September 2021Page: e916-e916 Advertisement Copyright & Permissions© 2021 by American Urological Association Education and Research, Inc.MetricsAuthor Information Sean Kern More articles by this author Isamu Tachibana More articles by this author Mohammad Mahmoud More articles by this author Timothy Masterson More articles by this author Nabil Adra More articles by this author Richard Foster More articles by this author Lawrence Einhorn More articles by this author Clint Cary More articles by this author Expand All Advertisement Loading ...