Retroperitoneal Node Research Articles

MP33-03 COMPARATIVE COST-EFFECTIVENESS OF TREATMENT STRATEGIES FOR STAGE IIA SEMINOMA: INSIGHTS FROM THE SEMS TRIAL

You have accessJournal of UrologyCME1 Apr 2023MP33-03 COMPARATIVE COST-EFFECTIVENESS OF TREATMENT STRATEGIES FOR STAGE IIA SEMINOMA: INSIGHTS FROM THE SEMS TRIAL Daniel D. Joyce, Kevin M. Wymer, Vidit Sharma, James P. Moriarty, Bijan J. Borah, Arman Walia, Brian A. Costello, Lance C. Pagliaro, Siamak Daneshmand, Bradley C. Leibovich, and Stephen A. Boorjian Daniel D. JoyceDaniel D. Joyce More articles by this author , Kevin M. WymerKevin M. Wymer More articles by this author , Vidit SharmaVidit Sharma More articles by this author , James P. MoriartyJames P. Moriarty More articles by this author , Bijan J. BorahBijan J. Borah More articles by this author , Arman WaliaArman Walia More articles by this author , Brian A. CostelloBrian A. Costello More articles by this author , Lance C. PagliaroLance C. Pagliaro More articles by this author , Siamak DaneshmandSiamak Daneshmand More articles by this author , Bradley C. LeibovichBradley C. Leibovich More articles by this author , and Stephen A. BoorjianStephen A. Boorjian More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000003266.03AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: The recent Surgery in Early Metastatic Seminoma (SEMS) trial examined retroperitoneal lymph node dissection (RPLND) as a first-line treatment for patients with isolated 1-3cm retroperitoneal lymphadenopathy. To date, the standard of care for these patients has been either chemotherapy or radiation (XRT). Herein, we evaluated the relative cost-effectiveness of these management strategies. METHODS: A decision-analytic Markov model was used to assess cost-effectiveness of RPLND, chemotherapy (3 cycles of cisplatin, etoposide, bleomycin), and XRT for management of stage IIA seminoma. Probabilities of progression for RPLND were obtained from SEMS trial presented abstract data. All other probability and utility values were obtained from published literature. Analyses were performed with a 3-month cycle for a lifetime horizon. Primary outcomes included costs from a commercial insurer’s perspective, effectiveness (quality adjusted life years, QALY), and incremental cost-effectiveness ratios (ICER). A willingness to pay threshold of $100,000/QALY was used. Sensitivity analyses were performed to evaluate model robustness. RESULTS: At a lifetime horizon, the mean costs per patient for RPLND, XRT, and chemotherapy were $41,291, $75,650, and $85,380, respectively. The mean QALYs per person were 41.65, 41.62, and 39.60 for RPLND, XRT, and chemotherapy, respectively. RPLND was found to be the most cost-effective approach due to high costs and the accrued disutility of chronic toxicities associated with both XRT (ICER: -$107,296/QALY) and chemotherapy (ICER: -$26,941/QALY). On one-way sensitivity analyses (Figure), RPLND was no longer cost-effective if the probabilities of infertility and cardiovascular toxicity after XRT were less than 4% and 1%, respectively. CONCLUSIONS: RPLND was the least costly and most effective treatment strategy for stage IIA seminoma. In particular, long-term toxicity costs and disutilities associated with chemotherapy and XRT resulted in lower cost-effectiveness for these two approaches. These findings support clinical guideline consideration of including RPLND as a treatment option for well selected patients with stage IIA seminoma . Source of Funding: None © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 209Issue Supplement 4April 2023Page: e450 Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.MetricsAuthor Information Daniel D. Joyce More articles by this author Kevin M. Wymer More articles by this author Vidit Sharma More articles by this author James P. Moriarty More articles by this author Bijan J. Borah More articles by this author Arman Walia More articles by this author Brian A. Costello More articles by this author Lance C. Pagliaro More articles by this author Siamak Daneshmand More articles by this author Bradley C. Leibovich More articles by this author Stephen A. Boorjian More articles by this author Expand All Advertisement PDF downloadLoading ...

MP33-04 THE EARLY RESULTS OF THE SWENOTECA (SWEDISH NORWEGIAN TESTICULAR CANCER GROUP) INTRODUCTION OF PRIMARY RETROPERITONEAL LYMPH NODE DISSECTION (RPLND) IN SEMINOMA STAGE IIA-IIB ≤ 3cm

You have accessJournal of UrologyCME1 Apr 2023MP33-04 THE EARLY RESULTS OF THE SWENOTECA (SWEDISH NORWEGIAN TESTICULAR CANCER GROUP) INTRODUCTION OF PRIMARY RETROPERITONEAL LYMPH NODE DISSECTION (RPLND) IN SEMINOMA STAGE IIA-IIB ≤ 3cm Anna Thor, Axel Gerdtsson, Bjarte Almas, Dag Halvorsen, Gabriella Cohn Cedermark, Helene Neegaard, Ingrid Glimelius, Hege Sagstuen Haugnes, Asa Karlsdottir, Olof Stahl, Signe Melsen Larsen, Anna Grenabo Bergdahl, Torgrim Tandstad, and Anders Kjellman Anna ThorAnna Thor More articles by this author , Axel GerdtssonAxel Gerdtsson More articles by this author , Bjarte AlmasBjarte Almas More articles by this author , Dag HalvorsenDag Halvorsen More articles by this author , Gabriella Cohn CedermarkGabriella Cohn Cedermark More articles by this author , Helene NeegaardHelene Neegaard More articles by this author , Ingrid GlimeliusIngrid Glimelius More articles by this author , Hege Sagstuen HaugnesHege Sagstuen Haugnes More articles by this author , Asa KarlsdottirAsa Karlsdottir More articles by this author , Olof StahlOlof Stahl More articles by this author , Signe Melsen LarsenSigne Melsen Larsen More articles by this author , Anna Grenabo BergdahlAnna Grenabo Bergdahl More articles by this author , Torgrim TandstadTorgrim Tandstad More articles by this author , and Anders KjellmanAnders Kjellman More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000003266.04AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Chemotherapy or radiotherapy have been the standard treatment for stage II seminomas with excellent results for survival but associated with significant long-term treatment-related toxicities. Several prospective trials have shown primary retroperitoneal lymph node dissection (RPLND) to be effective and safe as an alternative treatment. These results made us change the guidelines in the latest update of the SWENOTECA treatment program making surgery with RPLND the primary treatment modality in seminoma stage IIA to IIB ≤ 3 cm with 1-2 metastatic nodes. We have done an update of the result of the patients treated by the new management program. METHODS: The RPLND surgery in Sweden and Norway are centralised to 5 hospitals all participating in this study. In the study we included both patients with recurrence after initial stage I disease and patients with stage IIA and B at diagnosis. The patients were operated between 2019 and 2022. We collected information on operation time, bleeding, peri- and postoperative complications. We also analysed the histology and if adjuvant chemotherapy was given. We followed the patients for any recurrence of disease. RESULTS: We have included 61 patients operated from January 2019 to September 2022. The number of operations per site varied from 4 to 22. The mean age of patients at time of RPLND was 42.6 years (range 25-79). 38 patients had stage I disease at diagnosis and a recurrence. 23 patients had stage IIA or IIB disease at diagnosis. At time of RPLND 46 patients had IIA-disease and 14 stage IIB-disease (one missing data). The histology from RPLND showed seminoma in 56 patients, necrosis in two patients, teratoma in one patient (two missing data). 24 patients were operated with robotic laparoscopic technique. Seven patients out of 61 had a Clavien-Dindo postoperative complication > 2. The patients have been followed for a median of 17 months (range 2-45). Five patients have had recurrences, three in operated template and two outside templates. CONCLUSIONS: Our early results of primary RPLND of seminomas IIA-IIB ≤ 3 cm, show promising results. Longer follow-up is required to fully ensure that this is a safe treatment option. Source of Funding: None © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 209Issue Supplement 4April 2023Page: e451 Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.MetricsAuthor Information Anna Thor More articles by this author Axel Gerdtsson More articles by this author Bjarte Almas More articles by this author Dag Halvorsen More articles by this author Gabriella Cohn Cedermark More articles by this author Helene Neegaard More articles by this author Ingrid Glimelius More articles by this author Hege Sagstuen Haugnes More articles by this author Asa Karlsdottir More articles by this author Olof Stahl More articles by this author Signe Melsen Larsen More articles by this author Anna Grenabo Bergdahl More articles by this author Torgrim Tandstad More articles by this author Anders Kjellman More articles by this author Expand All Advertisement PDF downloadLoading ...

MP50-13 OPEN VERSUS MINIMAL INVASIVE RETROPERITONEAL LYMPH NODE DISSECTION: A NATIONAL CANCER DATABASE ANALYSIS

You have accessJournal of UrologyCME1 Apr 2023MP50-13 OPEN VERSUS MINIMAL INVASIVE RETROPERITONEAL LYMPH NODE DISSECTION: A NATIONAL CANCER DATABASE ANALYSIS Harshit Garg, Mukund Bhandari, Gilda Digman, Onika Noel, Furkan Dursun, Dharam Kaushik, Deepak Pruthi, Michael Liss, Chethan Ramamurthy, and Ahmed Mansour Harshit GargHarshit Garg More articles by this author , Mukund BhandariMukund Bhandari More articles by this author , Gilda DigmanGilda Digman More articles by this author , Onika NoelOnika Noel More articles by this author , Furkan DursunFurkan Dursun More articles by this author , Dharam KaushikDharam Kaushik More articles by this author , Deepak PruthiDeepak Pruthi More articles by this author , Michael LissMichael Liss More articles by this author , Chethan RamamurthyChethan Ramamurthy More articles by this author , and Ahmed MansourAhmed Mansour More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000003298.13AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Minimal invasive retroperitoneal lymph node dissection (RPLND), either by laparoscopic or robotic approach, has increasingly become popular. However, data comparative data on perioperative outcomes and survival outcomes is limited. In this study, we aim to compare minimal invasive -RPLND (MI-RPLND) with open (O-RPLND) using National Cancer Database. METHODS: Using the 2010-2019 National Cancer Database, patients with primary testicular germ cell tumors undergoing RPLND were identified and classified as Group A: O-RPLND and Group B: MI-RPLND. The primary outcome was overall survival (OS). Secondary outcomes included lymph nodal yield, death within 30 and 90 days of surgery, length of stay after surgery, and frequency of unplanned readmission within 30 days of surgical discharge. Inverse probability weighting (IPW) was utilized to balance the two groups. RESULTS: Overall, 3,184 patients were identified; 2971 (93.3%) patients were included in Group A and 213(6.7%) patients were included in Group B. Amongst them, 2419 (76%) had NSGCT. Factors associated with increased likelihood of MI-RPLND were treatment at academic research programs (p=0.003) and the treatment period between 2015-2019 (p<0.001). The median lymph nodal yield in O-RPLND and MI-RPLND group were similar [19 vs 22, p=0.623]. The 5-year OS was similar between the two groups [94.3% in O-RPLND vs 94.7%, in MI-RPLND p=0.77) (Figure 1a). The length of stay after surgery (p=0.623), frequency of unplanned readmission within 30 days of discharge (p=0.728), death within 30-days of surgery (p=0.74) and death within 90-days of surgery (p=0.06) were similar between the two groups. After IPW matched cohort analysis, the 5y-OS remained similar between the open and minimally invasive approach. [93.9% in O-RPLND vs 93.7% in MI-RPLND, p=0.94] (Figure 1b). CONCLUSIONS: Both O-RPLND and MI-RPLND are associated with similar OS. In terms of perioperative outcomes, both surgical approaches have similar length of hospital stay, similar rates of mortality within 30-day and 90-day of surgery, and similar rates of unplanned readmission rate within 30 days of surgical discharge. Source of Funding: None © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 209Issue Supplement 4April 2023Page: e689 Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.MetricsAuthor Information Harshit Garg More articles by this author Mukund Bhandari More articles by this author Gilda Digman More articles by this author Onika Noel More articles by this author Furkan Dursun More articles by this author Dharam Kaushik More articles by this author Deepak Pruthi More articles by this author Michael Liss More articles by this author Chethan Ramamurthy More articles by this author Ahmed Mansour More articles by this author Expand All Advertisement PDF downloadLoading ...

MP33-18 SURGICAL AND ONCOLOGIC OUTCOMES OF SURGERY IN EARLY METASTATIC SEMINOMA: MULTI-INSTITUTIONAL RETROSPECTIVE STUDY

You have accessJournal of UrologyCME1 Apr 2023MP33-18 SURGICAL AND ONCOLOGIC OUTCOMES OF SURGERY IN EARLY METASTATIC SEMINOMA: MULTI-INSTITUTIONAL RETROSPECTIVE STUDY Sanam Ladi-Seyedian, Muhannad Alsyouf, Brian Hu, Clint Cary, Timothy Masterson, Lawrence Einhorn, Nabil Adra, Stephen A. Boorjian, Christian Kollmannsberger, Anne Schuckman, Alan So, Peter Black, Aditya Bagrodia, Eila Skinner, Mehrdad Alemozaffar, Timothy Brand, Scott Eggener, Phillip Pierorazio, Kelly Stratton, Lucia Nappi, Craig Nichols, Axel Heidenreich, and Siamak Daneshmand Sanam Ladi-SeyedianSanam Ladi-Seyedian More articles by this author , Muhannad AlsyoufMuhannad Alsyouf More articles by this author , Brian HuBrian Hu More articles by this author , Clint CaryClint Cary More articles by this author , Timothy MastersonTimothy Masterson More articles by this author , Lawrence EinhornLawrence Einhorn More articles by this author , Nabil AdraNabil Adra More articles by this author , Stephen A. BoorjianStephen A. Boorjian More articles by this author , Christian KollmannsbergerChristian Kollmannsberger More articles by this author , Anne SchuckmanAnne Schuckman More articles by this author , Alan SoAlan So More articles by this author , Peter BlackPeter Black More articles by this author , Aditya BagrodiaAditya Bagrodia More articles by this author , Eila SkinnerEila Skinner More articles by this author , Mehrdad AlemozaffarMehrdad Alemozaffar More articles by this author , Timothy BrandTimothy Brand More articles by this author , Scott EggenerScott Eggener More articles by this author , Phillip PierorazioPhillip Pierorazio More articles by this author , Kelly StrattonKelly Stratton More articles by this author , Lucia NappiLucia Nappi More articles by this author , Craig NicholsCraig Nichols More articles by this author , Axel HeidenreichAxel Heidenreich More articles by this author , and Siamak DaneshmandSiamak Daneshmand More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000003266.18AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: The long-term toxicities of chemotherapy and radiotherapy can represent a significant burden to testicular cancer survivors. Although retroperitoneal lymph node dissection (RPLND) is an established treatment for testicular germ cell tumors, little data exists on its efficacy as a front-line treatment in early metastatic (stage II) seminoma. This study aims to assess the surgical and oncologic outcomes of RPLND as the primary treatment of stage II seminoma using multi-institutional dataset. METHODS: In this retrospective study, we included adult patients with Stage II testicular seminoma who underwent RPLND as the first-line treatment for their early metastatic disease. Patients’ characteristics, perioperative findings, and recurrence data were reviewed from 12 institutions in the North America and 1 site in Europe. RESULTS: A total of 94 patients with a median age of 35 (IQR 31 – 43) were enrolled with retroperitoneal lymphadenopathy between 1 - 5 cm. Two cases were performed robotically. An average of 23 (IQR 16 – 37) lymph nodes were removed. Pathologic upstaging occurred in 30% of patients. Of the 94 enrolled patients,11% were pN0, 30% pN1, 56% pN2, and 3% pN3. Overall, the recurrence free survival at 3 years was 82% and overall survival was 100%. Patient with pN2-3 showed significantly worse recurrence free survival than pN1 disease (78.5% versus 92%; P=0.04) (Figure 1). shows the surgical and postoperative outcomes of the cohort stratified by pathologic staging. In total, 7 (7.5%) patients experienced post-operative complications including ileus, incision ulceration, pulmonary embolism and chylous ascites. CONCLUSIONS: The finding of this retrospective multi-institutional study establishes RPLND as a viable option for first-line treatment of testicular seminoma with clinically low-volume retroperitoneal lymphadenopathy. It is associated with a low complication rate and high recurrence-free survival. Source of Funding: None © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 209Issue Supplement 4April 2023Page: e457 Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.MetricsAuthor Information Sanam Ladi-Seyedian More articles by this author Muhannad Alsyouf More articles by this author Brian Hu More articles by this author Clint Cary More articles by this author Timothy Masterson More articles by this author Lawrence Einhorn More articles by this author Nabil Adra More articles by this author Stephen A. Boorjian More articles by this author Christian Kollmannsberger More articles by this author Anne Schuckman More articles by this author Alan So More articles by this author Peter Black More articles by this author Aditya Bagrodia More articles by this author Eila Skinner More articles by this author Mehrdad Alemozaffar More articles by this author Timothy Brand More articles by this author Scott Eggener More articles by this author Phillip Pierorazio More articles by this author Kelly Stratton More articles by this author Lucia Nappi More articles by this author Craig Nichols More articles by this author Axel Heidenreich More articles by this author Siamak Daneshmand More articles by this author Expand All Advertisement PDF downloadLoading ...

MP50-09 CONTEMPORARY OUTCOMES OF PRIMARY EXTRAPERITONEAL RETROPERITONEAL LYMPH NODE DISSECTION FOR STAGE II GERM CELL TUMORS

You have accessJournal of UrologyCME1 Apr 2023MP50-09 CONTEMPORARY OUTCOMES OF PRIMARY EXTRAPERITONEAL RETROPERITONEAL LYMPH NODE DISSECTION FOR STAGE II GERM CELL TUMORS Muhannad Alsyouf, Arman Ashrafi, Sanam Ladi Seyedian, Erika L. Wood, Antoin Douglawi, Hamed Ahmadi, Madeleine Burg, Alireza Ghoreifi, Sumeet Bhanvadia, Anne Schuckman, Hooman Djaladat, and Siamak Daneshmand Muhannad AlsyoufMuhannad Alsyouf More articles by this author , Arman AshrafiArman Ashrafi More articles by this author , Sanam Ladi SeyedianSanam Ladi Seyedian More articles by this author , Erika L. WoodErika L. Wood More articles by this author , Antoin DouglawiAntoin Douglawi More articles by this author , Hamed AhmadiHamed Ahmadi More articles by this author , Madeleine BurgMadeleine Burg More articles by this author , Alireza GhoreifiAlireza Ghoreifi More articles by this author , Sumeet BhanvadiaSumeet Bhanvadia More articles by this author , Anne SchuckmanAnne Schuckman More articles by this author , Hooman DjaladatHooman Djaladat More articles by this author , and Siamak DaneshmandSiamak Daneshmand More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000003298.09AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Patients with germ cell tumors (GCT) and clinically low volume retroperitoneal adenopathy have multiple treatment options offering excellent oncologic outcomes. Primary retroperitoneal lymph node dissection (RPLND) is a treatment option that avoids the long term side effects of systemic therapies, however, can be associated with short term morbidity. The objective of this study was to evaluate the perioperative and oncologic outcomes of GCT patients who underwent a primary RPLND via an open extraperitoneal approach (EP RPLND) for the management of clinical stage II (CSII) GCT. METHODS: All GCT patients with marker negative, CSII who underwent a primary EP-RPLND between 2010-2021 were reviewed. The study population included patients with clinical stage (CS)I with retroperitoneal relapse & de-novo CSII patients. Perioperative, ejaculatory function, & oncologic outcomes were evaluated including recurrence rates and patterns. RESULTS: Overall, 45/170 EP-RPLND were performed in the primary setting (20 seminoma, 45 NSGCT). Median radiologic disease size was 1.7cm(IQR 1.3-2.3). Median number of lymph nodes resected was 35(IQR 23–46.5). Three patients (6.7%) experienced a 90-day complication. There were no cases of postoperative ileus, and median hospital stay was 2(IQR 1-3) days. In patients who underwent nerve sparing, 40/44 (91%) maintained antegrade ejaculatory function. pN+ rate was 90% in seminoma and 68% in NSGCT. In seminoma patients, 20 underwent a primary EP-RPLND. At a follow-up of 37.4 months, only 2 patients (10%) with stage IIA developed recurrence: 1 in-field (at 33.3 months follow-up) and 1 outside-field recurrence (at 42.7 months). Both were successfully managed with subsequent surgical resection, with an overall survival (OS) and systemic treatment free survival (STFS) of 100%. In 25 NSGCT patients with a median follow-up of 20.9 months, there were 6 recurrences (24%, 3 stage IIA, 3 stage IIB) at a median time of 3.1 months. All of these recurrences were successfully managed with chemotherapy (OS 100%, STFS 76%). CONCLUSIONS: In CSII GCT, a primary EP RPLND is safe, associated with short hospitalization, and offers excellent oncologic outcomes while minimizing patients morbidity. In this series, all seminoma patients and 76% of NSGCT patients avoided systemic therapy. Source of Funding: None © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 209Issue Supplement 4April 2023Page: e688 Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.MetricsAuthor Information Muhannad Alsyouf More articles by this author Arman Ashrafi More articles by this author Sanam Ladi Seyedian More articles by this author Erika L. Wood More articles by this author Antoin Douglawi More articles by this author Hamed Ahmadi More articles by this author Madeleine Burg More articles by this author Alireza Ghoreifi More articles by this author Sumeet Bhanvadia More articles by this author Anne Schuckman More articles by this author Hooman Djaladat More articles by this author Siamak Daneshmand More articles by this author Expand All Advertisement PDF downloadLoading ...

Comparison of the perioperative outcomes of laparoscopic and open retroperitoneal lymph node dissection for low-stage (stage I/II) testicular germ cell tumors: a systematic review and meta-analysis.

Comparison of the perioperative outcomes of laparoscopic retroperitoneal lymph node dissection (L-RPLND) and open retroperitoneal lymph node dissection (O-RPLND) for low-stage (stage I/II) testicular germ cell tumors. The authors performed a systematic review and cumulative meta-analysis of the primary outcomes of interest according to PRISMA criteria, and the quality assessment of the included studies followed the AMSTAR guidelines. Four databases were searched, including Embase, PubMed, the Cochrane Library, and Web of Science. The search period was from the creation of each database to October 2022. The statistical analysis software uses Stata17. There were nine studies involving 579 patients. Compared with O-RPLND, L-RPLND was associated with shorter length of stay [weighted mean difference (WMD)=-3.99, 95% CI: -4.80 to -3.19, P <0.05], less estimated blood loss (WMD=-0.95, 95% CI: -1.35 to -0.54, P <0.05), shorter time to oral intake after surgery (WMD=-0.77, 95% CI: -1.50 to -0.03, P <0.05), and lower overall complications (odds ratio=0.58, 95% CI: 0.38-0.87, P <0.05). Subgroup analysis found that the complication rate of Clavien-Dindo grade II was lower in L-RPLND (odds ratio=0.24, 95% CI: 0.11-0.55, P <0.05). Interestingly, there was no statistically significant difference between the two groups in terms of operation time, lymph node yields, and recurrence rate during follow-up. L-RPLND is superior to O-RPLND and is worthy of clinical promotion.

MP33-19 MOLECULAR CHARACTERISTICS AND ACTIONABLE TARGETS OF TESTICULAR GERM CELL TUMORS IN REAL-WORLD CONDITIONS

You have accessJournal of UrologyCME1 Apr 2023MP33-19 MOLECULAR CHARACTERISTICS AND ACTIONABLE TARGETS OF TESTICULAR GERM CELL TUMORS IN REAL-WORLD CONDITIONS Rafael Morales-Grimany, Cesar Delgado, Fady Baky, Armon Amini, Thomas Gerald, Rohit R Badia, Jacob Taylor, Luke L Wang, Juan Javier-Desloges, Vitaly Margulis, Solomon L. Woldu, Amir Salmasi, Fred Millard, Rana R. Mckay, and Aditya Bagrodia Rafael Morales-GrimanyRafael Morales-Grimany More articles by this author , Cesar DelgadoCesar Delgado More articles by this author , Fady BakyFady Baky More articles by this author , Armon AminiArmon Amini More articles by this author , Thomas GeraldThomas Gerald More articles by this author , Rohit R BadiaRohit R Badia More articles by this author , Jacob TaylorJacob Taylor More articles by this author , Luke L WangLuke L Wang More articles by this author , Juan Javier-DeslogesJuan Javier-Desloges More articles by this author , Vitaly MargulisVitaly Margulis More articles by this author , Solomon L. WolduSolomon L. Woldu More articles by this author , Amir SalmasiAmir Salmasi More articles by this author , Fred MillardFred Millard More articles by this author , Rana R. MckayRana R. Mckay More articles by this author , and Aditya BagrodiaAditya Bagrodia More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000003266.19AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Molecular features of testicular germ cell tumors (GCT) in various clinical states (pre- vs post-chemotherapy, localized versus metastatic) may inform treatment options for patients with recurrence after definitive therapy. In his study, we describe molecular features and potential therapeutic targets in a cohort of patients with testicular GCT. METHODS: We retrospectively examined clinicopathologic and next-generation sequencing (NGS) data from 27 patients with GCT. Tumors were sequenced using the TempusxT solid tumor assay, which includes DNA sequencing of 595-648 genes at 500x coverage and RNA sequencing for all human coding genes. Tumor mutational burden (TMB) was measured for all tumors and PD-L1 levels were assessed qualitatively by 22C3 pharmDx immunohistochemistry assay in 8 patients. All genetic variants detected were quantified and analyzed to identify potentially actionable targets. RESULTS: We identified 13 (48%) stage I GCT, 11 (41%) stage II, and 3 (11%) stage III. There were 7 seminomas and 20 nonseminomas. 12 tumor specimen resections were obtained from orchiectomy, and 15 from retroperitoneal lymph node dissection (RPLND), of which, 8 were chemotherapy-naïve and 7 were post-chemotherapy. Chemo-naïve RPLND histology showed a combination of teratoma, seminoma, and mixed GCT, while post-chemo histology revealed 6 teratomas and 9 benign pathologies. The median TMB for the cohort was 0.75 mutations/megabase. Somatic mutations were identified in 55% of patients and most commonly within: KRAS (25.9%), KIT (11.1%), and PIK3CB (7.4%). PD-L1 expression was observed in 75% of the tumors measured (60% positivity at stage I and 100% positivity at stage III). Microsatellite stability was stable in 18 tumors tested. DNA alterations- [single base pair substitutions, insertions, and deletions]- in KRAS (GTPase) proto-oncogenes were detected in 7 tumors and tyrosine kinase receptor gene variants (KIT, P1K3CB) were found at similar frequencies across disease stages. Whole transcriptome NGS RNA expression assays were performed on 21 untreated specimens revealing overexpression of MTOR (33%), MAPK1(14%), and MET (8.0%). Actionable targets with FDA-approved therapies in other organ tissues were detected in 11 patients (40.7%). Incidental germline mutations, including MSH6, RB1, and MSH2, were identified in 9 patients though all were variants of unknown significance. CONCLUSIONS: In our study, a significant proportion of patients had potentially actionable molecular targets across the disease spectrum. The identified genetic alterations provide a genomic landscape for risk stratification, future therapies, and molecularly informed treatment paradigms for GCT patients. Source of Funding: Cancer Prevention and Research Institute © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 209Issue Supplement 4April 2023Page: e458 Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.MetricsAuthor Information Rafael Morales-Grimany More articles by this author Cesar Delgado More articles by this author Fady Baky More articles by this author Armon Amini More articles by this author Thomas Gerald More articles by this author Rohit R Badia More articles by this author Jacob Taylor More articles by this author Luke L Wang More articles by this author Juan Javier-Desloges More articles by this author Vitaly Margulis More articles by this author Solomon L. Woldu More articles by this author Amir Salmasi More articles by this author Fred Millard More articles by this author Rana R. Mckay More articles by this author Aditya Bagrodia More articles by this author Expand All Advertisement PDF downloadLoading ...

MP50-07 CONTEMPORARY SHORT-TERM OUTCOMES FOR OPEN VIRGIN RETROPERITONEAL LYMPH NODE DISSECTION

You have accessJournal of UrologyCME1 Apr 2023MP50-07 CONTEMPORARY SHORT-TERM OUTCOMES FOR OPEN VIRGIN RETROPERITONEAL LYMPH NODE DISSECTION Jacob Mcfadden, Timothy Masterson, and Clint Cary Jacob McfaddenJacob Mcfadden More articles by this author , Timothy MastersonTimothy Masterson More articles by this author , and Clint CaryClint Cary More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000003298.07AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Retroperitoneal lymph node dissection (RPLND) remains an important therapeutic option for select men with clinical stage I and clinical stage II testicular cancer. Refinement of the open surgical technique has led to improved outcomes and morbidity profiles for this procedure over the past two decades. As techniques continue to evolve in hopes of improving surgical morbidity, contemporary reporting of the current standard of care is increasingly important. Thus, we report current perioperative outcomes and short-term complication rates for open virgin retroperitoneal lymph node dissection (O-VRPLND), with analysis of risk factors for complications in a consecutive single-institution series. METHODS: The institutional Indiana University Testicular Cancer database was utilized to identify all patients that underwent O-VRPLND over the study period (2018-2020). Demographic, perioperative, and pathologic variables were collected. Retrospective chart review was performed. Short term complications were graded using the Clavien-Dindo classification. The primary outcomes of interest were the contemporary preoperative profile of patients undergoing O-VRPLND, overall complication rates, and identification of risk factors associated with any complication. RESULTS: During the study period 165 patients were identified. Median BMI was 28.6, with a median ASA III classification. The majority (63.6%) of patients underwent O-VRPLND for non-seminomatous germ cell tumors compared with 30.9% for seminomas; patients were most often clinical stage IIA (39%) or IIB (36%) at the time of surgery. Median estimated blood loss (EBL) was 150cc, with no transfusions required. Among all preoperative and intraoperative variables, only BMI demonstrated significant association with development of any postoperative complication (mean BMI of 34.46 for patients with any complication, versus 28.94 for patients with normal recovery; p=0.0042). Median hospital stay was 3 days. Overall complication rate was low (8.48%), with one major postoperative complication and no deaths in the 30-day period. CONCLUSIONS: Open virgin RPLND has an acceptable morbidity profile, even among a cohort of predominantly overweight young patients with high ASA scores. Low EBL, short hospital stay, low 30-day readmission rate, and rare major postoperative complications may reflect the new benchmark for virgin RPLND. Source of Funding: None © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 209Issue Supplement 4April 2023Page: e687 Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.MetricsAuthor Information Jacob Mcfadden More articles by this author Timothy Masterson More articles by this author Clint Cary More articles by this author Expand All Advertisement PDF downloadLoading ...

Retroperitoneal germ cell tumor, primary or secondary: A diagnostic conundrum

Abstract Germ cell tumor, seminoma, is the most common cancer in young men’s testis. However, a small subset of tumors (1%–2%) originate in other locations and are referred to as primary extragonadal germ cell tumors. But such type of tumors’ origin is thought to be controversial as a significant bulk may represent metastases from primary occult/regressed testicular germ cell tumors. The entire primary extragonadal germ cell tumor is mostly non-seminomatous and present in higher ages than primary testicular germ cell tumors, most of which are seminoma. A 50-year-old male presented with a brief history of abdominal pain for 10 days. Ultrasonography of his abdomen revealed multiple enlarged retroperitoneal lymph nodes. Biopsy and immunohistochemistry of the left iliac node showed features consistent with metastatic seminoma. Ultrasound of the left testis showed a hypoechoic lesion. Positron emission tomography scan showed increased tracer uptake in both the testes without any abnormal enhancing mass lesion and increased fluorodeoxyglucose uptake in the retroperitoneal lymph nodes. A high left inguinal orchidectomy revealed no tumor but a fibrotic scar tissue showing atrophic and ghost tubules, dense lymphoplasmacytic cells, and increased vascularity, implying regressed (burnt-out) seminoma. Regression of testicular seminoma shows a distinct constellation of findings permitting its diagnosis as a primary testicular tumor, which is imminent from a prognostic and therapeutic perspective.

Surgical Management and Oncologic Outcomes for Local Retroperitoneal Recurrence of Renal Cell Carcinoma After Radical Nephrectomy.

Local retroperitoneal recurrence (RPR) after racial nephrectomy (RN) of renal cell carcinoma (RCC) remains a therapeutic challenge and has a poor prognosis. We aimed to compare the oncological outcomes of patients with RPR treated with RPR surgery or targeted therapy alone and assess the prognostic factors of these patients. This is a retrospective multi-center study of patients with RPR after prior RN treated with or without surgical treatment from 2008 to 2020. RPR of RCC is defined as an ipsilateral recurrence confined to the renal fossa, adrenal gland or retroperitoneal lymph nodes after prior nephrectomy, which was diagnosed by cross-sectional imaging. Clinical and pathological features, perioperative complications were reported using descriptive statistics. Cancer-specific survival (CSS) was evaluated by Kaplan-Meier method and studied using Cox proportional hazards model. Median follow-up period was 35 months (IQR 20-61) for the RPR surgery group and 23 months (IQR 9-40.5) for the targeted therapy group. No patients had distant metastatic disease at the time of RPR diagnosis. Treatment with RPR surgery resulted in significantly longer CSS than targeted therapy alone (P < .001). In multivariable analysis, high Fuhrman grade, size of RPR tumor, mixed type of RPR, multiple recurrence lesions and the absence of RPR surgery were associated with a significantly increased risk of death from RCC. Aggressive surgical resection of RPR after RN represents a potentially curative treatment for selected RCC patients without synchronous metastases, resulting in significantly longer CSS than targeted therapy alone.

MP33-01 RISK OF RESIDUAL TERATOMA AFTER COMPLETE RESPONSE FOLLOWING FIRST-LINE CHEMOTHERAPY IN MEN WITH METASTATIC NON-SEMINOMATOUS GERM CELL TUMOR AND IGCCCG INTERMEDIATE/POOR PROGNOSIS: A MULTI-INSTITUTIONAL RETROSPECTIVE COHORT STUDY

MP33-01 RISK OF RESIDUAL TERATOMA AFTER COMPLETE RESPONSE FOLLOWING FIRST-LINE CHEMOTHERAPY IN MEN WITH METASTATIC NON-SEMINOMATOUS GERM CELL TUMOR AND IGCCCG INTERMEDIATE/POOR PROGNOSIS: A MULTI-INSTITUTIONAL RETROSPECTIVE COHORT STUDY

MP50-06 SURVIVAL OF TESTICULAR PURE TERATOMA VS. MIXED GERM CELL TUMOR PATIENTS ACROSS ALL STAGES

MP50-06 SURVIVAL OF TESTICULAR PURE TERATOMA VS. MIXED GERM CELL TUMOR PATIENTS ACROSS ALL STAGES

MP50-08 POST-CHEMOTHERAPY RETROPERITONEAL LYMPH NODE DISSECTION (PC-RPLND) FOR SEMINOMA: IS SURGERY EFFECTIVE?

You have accessJournal of UrologyCME1 Apr 2023MP50-08 POST-CHEMOTHERAPY RETROPERITONEAL LYMPH NODE DISSECTION (PC-RPLND) FOR SEMINOMA: IS SURGERY EFFECTIVE? Isamu Tachibana, Andre Alabd, Rumeal Whaley, Jacob Mcfadden, Alex Piroozi, Sean Kern, Nabil Adra, Richard Foster, Lawrence Einhorn, Clint Cary, and Timothy Masterson Isamu TachibanaIsamu Tachibana More articles by this author , Andre AlabdAndre Alabd More articles by this author , Rumeal WhaleyRumeal Whaley More articles by this author , Jacob McfaddenJacob Mcfadden More articles by this author , Alex PirooziAlex Piroozi More articles by this author , Sean KernSean Kern 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 , Clint CaryClint Cary More articles by this author , and Timothy MastersonTimothy Masterson More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000003298.08AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Patients with relapsed seminoma after first-line chemotherapy can be treated with salvage chemotherapy or post-chemotherapy retroperitoneal lymph node dissection (PC-RPLND). Based on prior reported experience, surgical management can have worse efficacy and increased morbidity compared to non-seminomatous germ cell tumor. Our aim was to characterize the surgical efficacy and difficulty in a specific cohort of patients with definite progression but minimal disease burden. METHODS: The Indiana University testis cancer database was queried to identify men who underwent PC-RPLND for seminoma between January 2011 to December 2021. Included patients only underwent first-line chemotherapy and could not have any evidence of non-seminomatous elements on orchiectomy or have elevated serum alpha-fetoprotein (AFP). All patient demonstrated high suspicion of retroperitoneal disease prior to PC-RPLND was based on increasing size of tumor on standard CT imaging, progression of FDG avidity on PET imaging, or elevated tumor markers. RESULTS: We identified 889 patients that underwent PC-RPLND, of which only 14 patients were operated on for seminoma. One patient was excluded for lack of meaningful follow-up. Out of 13 patients, only 3 patients were disease free with surgery and did not have to undergo salvage chemotherapy. Median follow up time was 29.9 months (IQR: 22.6-53.7). Two patients died due to testicular cancer. The remaining 8 patients were treated successfully with salvage chemotherapy. For additional procedures, 4 patients required a nephrectomy, 1 patient required an aortic graft, 2 patients required a partial ureterectomy, and 3 patients required partial or complete caval resection CONCLUSIONS: The decision between salvage chemotherapy and PC-RPLND as second-line therapy can be challenging. Salvage chemotherapy is effective but is associated with short and long-term morbidity. Surgical efficacy in this setting seems to be limited, but careful selection of patients may lead to surgical success without life threatening morbidity or adjunctive procedures that may compromise the ability to receive salvage chemotherapy. Source of Funding: None © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 209Issue Supplement 4April 2023Page: e687 Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.MetricsAuthor Information Isamu Tachibana More articles by this author Andre Alabd More articles by this author Rumeal Whaley More articles by this author Jacob Mcfadden More articles by this author Alex Piroozi More articles by this author Sean Kern 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 Timothy Masterson More articles by this author Expand All Advertisement PDF downloadLoading ...

MP50-15 TESTICULAR RADIOMICS CORRELATED WITH PATHOLOGY AT TIME OF POST-CHEMOTHERAPY RETROPERITONEAL LYMPH NODE DISSECTION FOR NON-SEMINOMATOUS GERM CELL TUMOR

You have accessJournal of UrologyCME1 Apr 2023MP50-15 TESTICULAR RADIOMICS CORRELATED WITH PATHOLOGY AT TIME OF POST-CHEMOTHERAPY RETROPERITONEAL LYMPH NODE DISSECTION FOR NON-SEMINOMATOUS GERM CELL TUMOR Nikit Venishetty, Jacob Taylor, Yin Xi, Jeffrey Howard, Yeeseng Ng, and Aditya Bagrodia Nikit VenishettyNikit Venishetty More articles by this author , Jacob TaylorJacob Taylor More articles by this author , Yin XiYin Xi More articles by this author , Jeffrey HowardJeffrey Howard More articles by this author , Yeeseng NgYeeseng Ng More articles by this author , and Aditya BagrodiaAditya Bagrodia More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000003298.15AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Testicular germ cell tumors are the most commonly diagnosed malignancy in men aged 20 to 39 years old, as a third of patients will have metastatic disease on presentation. Post-chemotherapy retroperitoneal lymph node dissection (PC-RPLND) is performed to treat patients with metastatic non-seminomatous germ cell tumor (NSGCT). Although 50% of patients will viable GCT or teratoma, there is no accurate measurement to predict pre-operatively which patients will have residual disease after chemotherapy. Our aim was to use testicular radiomics data, a method that collects quantitative tumor imaging data from conventional imaging, to predict pathology after PC-RPLND. METHODS: Radiomics, clinical, and pathologic data were extracted from 45 patients with metastatic NSGCT undergoing PC-RPLND. An abdominal radiologist drew regions of interest (ROI) around metastatic notes, and PyRadiomics was used to extract first order, shape, and second order statistics from each ROI. T-Tests were performed to differentiate radiomics features between binary pathology type. P values were adjusted using the BH method to control false discovery rate. Python 3.7 and R 4.2.0 used for additional statistical analyses. RESULTS: There were 16 clinical stage II patients and 28 clinical stage III. 42% of patients had necrosis on PC-RPLND pathology, while 53% and 4% patients had teratoma and viable germ cell tumor, respectively. First order statistics mean, median, 90th percentile, and root mean squares were significant (Table 1). No significant differences was observed in other first order, shape, or texture features. We also show that the first order statistics above as significant, while the other radiomic statistics were not significant. CONCLUSIONS: Testicular radiomics is a tool that can help predict which patients with metastatic NSGCT are at higher risk of persistent disease after chemotherapy. We found relatively few first-order radiomic variables that were correlated with post-operative pathology. Results may have also been less predictive given small number of patients (4%) with residual GCT at time of RPLND. Further precision of extraction of the radiomics data may improve clinical decision-making in patients with metastatic NSGCT after chemotherapy prior to RPLND. Source of Funding: N/A © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 209Issue Supplement 4April 2023Page: e690 Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.MetricsAuthor Information Nikit Venishetty More articles by this author Jacob Taylor More articles by this author Yin Xi More articles by this author Jeffrey Howard More articles by this author Yeeseng Ng More articles by this author Aditya Bagrodia More articles by this author Expand All Advertisement PDF downloadLoading ...

MP33-14 EVALUATION OF miRNA-371a-3p (miR371a) ASSAY TO PREDICT FINAL PATHOHISTOLOGY IN PATIENTS UNDERGOING PRIMARY NERVE-SPARING RETROPERITONEAL LYMPHADENECTOMY (nsRPLND) FOR STAGE IIA/B SEMINOMAS AND NON-SEMINOMAS

You have accessJournal of UrologyCME1 Apr 2023MP33-14 EVALUATION OF miRNA-371a-3p (miR371a) ASSAY TO PREDICT FINAL PATHOHISTOLOGY IN PATIENTS UNDERGOING PRIMARY NERVE-SPARING RETROPERITONEAL LYMPHADENECTOMY (nsRPLND) FOR STAGE IIA/B SEMINOMAS AND NON-SEMINOMAS Felix Seelemeyer, David Pfister, Claudia Stammel, Roberto Pappesch, Sabine Merkelbach-Bruse, Pia Paffenholz, and Axel Heidenreich Felix SeelemeyerFelix Seelemeyer More articles by this author , David PfisterDavid Pfister More articles by this author , Claudia StammelClaudia Stammel More articles by this author , Roberto PappeschRoberto Pappesch More articles by this author , Sabine Merkelbach-BruseSabine Merkelbach-Bruse More articles by this author , Pia PaffenholzPia Paffenholz More articles by this author , and Axel HeidenreichAxel Heidenreich More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000003266.14AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: NS-RPLND represents a guideline recommended treatment option in marker negative low volume metastatic seminomas and nonseminomas (NSGCT). However, about 30% of clinical stage IIA patients demonstrate equivocal findings of uncertain dignity so that they mgith undergo unnecessary treatment. Elevated serum concentrations of the molecular marker miR371 have been reported to correlate with the clinical stage even in small volume metastases. It was the purpose of our pilot study to evaluate the predictive accuracy of miR371 in a cohort of patients who underwent nsRPLND for clinical stage IIA/B germ cell tumors of the testis. METHODS: Between 1-9/2022, 16 patients with marker negative clinical stage IIA/B seminomas (n=10) and NSGCT (n=6) underwent primary nsRPLND with a modified template resection via an open surgical approach. Blood specimens (20ml) were drawn on the day immediately prior to surgery and processed according to the manufacturer’s protocol. miRNA is extracted and purified with the Maxwell® RSC MiRNA Plasma and Serum Kits prior to its transcription into cDNA using cDNA Solution, Reverse Transcriptase and RNase Inhibitor. Subsequently, this cDNA is amplified. Using qPCR techniques, the miRNA 371a is quantified using Roche Lightcycler 480 II. Using the Lightcycler software, the median Cp (CP = crossing points) of the triplicates is calculated and converted into a RQ value (RQ= relative abundance). RESULTS: NsRPND was performed in all patients without significant Clavien-Dindo IIIa-V complications. Mean OR time was 131 (105-195) minutes, mean blood loss was < 150ml, transfusion rate was 0%. Mean number of dissected lymph nodes was 17 (7-32), mean diameter of positive lymph nodes was 2.1 (0.8-4.1) cm. Histology revealed metastatic seminoma or nonseminoma in 12/16 (75%). In 4 patients histology revealed non-malignant disease (n=2), teratoma, and lymphoma. miR371 was positive in all 12 (100%) pts with metastases and it was negative in 3/4 (75%) pts without metastases. One patient with small volue CS IIA seminoma was false negative. CONCLUSIONS: This is the first report to demonstrate that miR371can be used as a personalized tumor marker to predict the presence of small volume retroperitoneal lymph node metastases in CS IIA/B seminomas and in nonseminomas. Patients with positive findings should undergo active treatment whereas negative findings should result in close follow-up. Date are currently validated in a multi-institutional trial. Source of Funding: None. © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 209Issue Supplement 4April 2023Page: e455 Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.MetricsAuthor Information Felix Seelemeyer More articles by this author David Pfister More articles by this author Claudia Stammel More articles by this author Roberto Pappesch More articles by this author Sabine Merkelbach-Bruse More articles by this author Pia Paffenholz More articles by this author Axel Heidenreich More articles by this author Expand All Advertisement PDF downloadLoading ...

Multimodal treatment with curative intent in a germline BRCA2 mutant metastatic ampullary adenocarcinoma: a case report

BackgroundCancers of the Vater ampulla (ampullary cancers, ACs) account for less than 1% of all gastrointestinal tumors. ACs are usually diagnosed at advanced stage, with poor prognosis and limited therapeutic options. BRCA2 mutations are identified in up to 14% of ACs and, differently from other tumor types, therapeutic implications remain to be defined. Here, we report a clinical case of a metastatic AC patient in which the identification of a BRCA2 germline mutation drove a personalized multimodal approach with curative-intent.Case presentationA 42-year-old woman diagnosed with stage IV BRCA2 germline mutant AC underwent platinum-based first line treatment achieving major tumor response but also life-threatening toxicity. Based on this, as well as on molecular findings and expected low impact of available systemic treatment options, the patient underwent radical complete surgical resection of both primary tumor and metastatic lesions. Following an isolated retroperitoneal nodal recurrence, given the expected enhanced sensitivity to radiotherapy in BRCA2 mutant cancers, the patient underwent imaging-guided radiotherapy leading to long-lasting complete tumor remission. After more than 2 years, the disease remains radiologically and biochemically undetectable. The patient accessed a dedicated screening program for BRCA2 germline mutation carriers and underwent prophylactic bilateral oophorectomy.ConclusionsEven considering the intrinsic limitations of a single clinical report, we suggest that the finding of BRCA germline mutations in ACs should be taken into consideration, together with other clinical variables, given their potential association with remarkable response to cytotoxic chemotherapy that might be burdened with enhanced toxicity. Accordingly, BRCA1/2 mutations might offer the opportunity of personalizing treatment beyond PARP inhibitors up to the choice of a multimodal approach with curative-intent.

Retrospective Analysis of a Cohort of Patients with Metastatic Bladder Cancer with Metastatic Sites Limited to the Pelvis and Retroperitoneum Treated at a Single Institution between 2009 and 2020.

Bladder cancer (BC) presenting with pelvic and retroperitoneal lymph nodes presents a therapeutic challenge. The impact of chemoradiotherapy on pelvic and retroperitoneal lymph node metastasis as a consolidation treatment has not been established. Between 2009 and 2020, 502 patients who were treated with first-line chemotherapy for BC in our center, were retrospectively identified. Patients who received chemoradiotherapy or radiotherapy with an equivalent radiation dose superior to 30 Gy were included in the RTCT group, and other patients were included in the control group (CT group). We performed an analysis of progression-free survival (PFS) and overall survival (OS) for these two cohorts using the Kaplan-Meier method. A total of 89 patients were included, 24 in the RTCT group and 65 in the CT group. Chemoradiotherapy improved both OS (p = 0.034) and PFS (p = 0.009) in comparison with chemotherapy alone: 26.3 months (95% IC 0.0-52.9) and 19.4 months (95% IC 5.0-33.7), respectively, in the RTCT group versus 17.2 months (95% IC 13.7-20.6) and 11.2 months (95% IC 8.6-13.8), respectively, in the CT group. Grade 3/4 toxicity was related to chemotherapy and to chemoradiotherapy at levels of 31% and 24%, respectively. For mBC with metastatic regional or retroperitoneal lymph nodes, chemoradiotherapy seems to confer benefits for both OS and PFS.

Seminoma arising in splenogonadal fusion: a case report and literature review

BackgroundSplenogonadal fusion (SGF) is a rare congenital malformation in which the spleen is abnormally connected to the gonads or to the mesonephric derivatives. There is no obvious causality between SGF and testicular neoplasm. However, cryptorchidism, which is a well-known risk factor of testicular germ cell tumors, are the most frequent malformations associated with SGF. To our knowledge, there are only four reported cases of SGF associated with testicular neoplasm so far. Herein, we reported a patient of this condition, and briefly reviewed the related literature.Case presentationA 48-year-old man was diagnosed with bilateral cryptorchidism 30 years prior, and only underwent a right orchiopexy for the left testicle could not be explored during the operation. At that time, doctors failed to realize the possibility of SGF due to the lack of sufficient knowledge of this condition. This time, the patient was treated for a left abdomen mass that was diagnosed as stage III metastatic seminoma. Then, a right orchiectomy, robot-assisted laparoscopic left retroperitoneal tumor resection, and left retroperitoneal lymph node dissection was performed after four cycles of BEP (bleomycin + etoposide + cisplatin) systemic chemotherapy in our center. The final diagnosis of SGF was made by postoperative pathology. The patient was re-examined in our center at 3 months and 6 months after the operation, and no obvious abnormalities were found.ConclusionsSurgeons should always bear in mind the possibility of association between bilateral cryptorchidism and splenogonadal fusion to avoid malignant transformation caused by delayed treatment.

Retroperitoneal solitary neurofibroma mimicking lymph node metastasis of colon cancer: a case report

BackgroundA neurofibroma is a benign tumor that arises from Schwann cells and neurofibromas occur throughout the skin of neurofibromatosis type 1 (NF-1: Von Recklinghausen’s disease) patients. A retroperitoneal solitary neurofibroma without any clinical signs of NF1 has been rarely reported. Herein, we present a case of a retroperitoneal solitary neurofibroma mimicking lymph node metastasis of colon cancer as well as a literature review.Case presentationAn 80-year-old woman with abdominal pain and nausea was transported and diagnosed with bowel obstruction arising from sigmoid colon cancer A colonic stent was inserted to alleviate the bowel obstruction. A computed tomography scan with contrast revealed a liver tumor in segment 3, and an enlarged lymph node around the abdominal aorta. Whole-body 18F-fluorodeoxyglucose-positron emission tomography–CT (FDG-PET–CT) examine revealed increased FDG uptake in the liver tumor and enlarged lymph node. Liver and distant lymph node metastasis were diagnosed and we made a plan for a two-stage operation of the colon cancer and the metastatic lesions because laparotomy resection was needed for the retroperitoneal lymph node. Laparoscopic sigmoid colectomy was performed first. Pathological examination showed a tubular adenocarcinoma. A laparotomy for the metastatic lesions was performed to ensure complete lymph node dissection secondly. Histopathological findings of the liver tumor showed metastasis of sigmoid colon cancer. However, the tissue regarded as the enlarged lymph node was diagnosed as a neurofibroma. No metastasis and recurrence were observed.ConclusionAlthough most neurofibromas are benign, malignant transformation of a neurofibroma is possible. PET–CT showed our patient had a high accumulated retroperitoneal tumor co-existing with colon cancer and liver metastasis. The treatment strategy of a solitary neurofibroma must be selected carefully considering the site of occurrence and the patient’s background and aggressive resection of a tumor co-existing with another malignant tumor is needed.

Interview: Timothy Clinton

Interview: Timothy Clinton