Rates of retroperitoneal lymph node dissection for stage I non-seminomatous germ cell tumors: Results from the National Cancer Database.

Abstract

395 Background: Per existing best practice guidelines, careful observation with serial imaging (active surveillance) or primary chemotherapy have supplanted primary retroperitoneal lymph node dissection (RPLND) for stage I non-seminomatous germ cell tumors (NSGCT). Hypothesizing that rates of primary RPLND have declined over the past decade, our objective was to assess temporal trends in primary treatment for stage I NSGCT using a large national cancer registry. Methods: The National Cancer Database (NCDB) was queried for all patients diagnosed with stage I NSGCT from 1998-2011. Temporal trends for receipt of primary RPLND, chemotherapy, or observation (defined as no treatment) were assessed. Adjusting for patient, demographics (age, ethnicity, race, insurance status, education, income, geographic location), and clinicopathologic characteristics (stage), multivariable logistic models were used to examine the association between available covariates and receipt of primary RPLND. Results: Of 15,822 patients identified over the study period, 9,001 (56.9%), 2,937 (18.6%), and 3,884 (24.5%) underwent observation, RPLND, and chemotherapy respectively. While rates of observation minimally changed over time (56.3 to 55.0%, p=0.85), a significant decrease in utilization of RPLND (23.0 to 12.4%, p<0.001) was matched by a significant increase in receipt of primary chemotherapy (20.7 to 32.5%, p<0.001). Rates of RPLND declined across all age groups—age < 30 (24.3% to 12.1%, P<0.0001), age 30-39 (21.6% to 13.8%, p <0.0001), age 40-49 (23.1% to 11.4%, p<0.0001), age>50 (20.0% to 11.7%, p = 0.02). Following adjustment, stage T2 (OR 0.79 [CI 0.72-0.87]) and T3 (OR 0.33 [CI 0.24-0.96]), and age categories 40-49 years (OR 0.83 [CI 0.72-0.94]) and ≥50 years (OR 0.66 [CI 0.52-0.82]) were associated with decreased utilization of RPLND. Conclusions: In hospitals reporting to the NCDB, utilization of primary RPLND for stage I NSGCT has significantly decreased over the last decade, while receipt of primary chemotherapy has increased over the same period. While employed in more than 50% of patients, rates of observation remain unchanged.