Predictors of outcome in patients undergoing postchemotherapy retroperitoneal lymph node dissection for testicular cancer

Abstract

BACKGROUNDThe management of metastatic nonseminomatous germ cell tumors (NSGCT) frequently consists of systemic chemotherapy followed by retroperitoneal lymph node dissection (PC‐RPLND). The aim of the present study was to evaluate the authors' PC‐RPLND experience and identify predictors of outcome in these patients.METHODSBetween 1980 and 2003, 236 patients with clinical Stage IIA‐III NSGCT underwent PC‐RPLND. Their medical records were retrospectively reviewed for pertinent clinical and treatment‐related outcomes. The 5‐year disease‐specific and recurrence‐free survival was 85% and 75%, respectively, with the median length of follow‐up after RPLND 45 months (6–250 months).RESULTSThe median age of patients at diagnosis was 28 years, with all patients receiving systemic chemotherapy (median of 5 cycles) before RPLND. On multivariate analysis, predictors of poorer disease‐specific survival (DSS) included systemic symptoms at presentation (P = .05), elevated pre‐RPLND serum alpha fetoprotein (AFP, P = .006) and β‐human chorionic gonadotropin (HCG, P = .004), postoperative complications (P = .03), and recurrence (P < .0001). Predictors of poorer recurrence‐free survival (RFS) included advanced clinical stage (IIC‐III, P = .001) and presence of viable tumor in the RPLND specimen (P = .03). A pre‐RPLND serum AFP > 9 ng/mL and HCG > 4.1 mIU/mL were found to predict a worse DSS (P = .03 and .03, respectively).CONCLUSIONSIn patients undergoing PC‐RPLND, preoperative tumor markers and the occurrence of postoperative complications or recurrence are predictive of poorer DSS. Advanced clinical stage and viable tumor in the surgical specimen predict worse RFS. Cancer 2006. © 2006 American Cancer Society.

Post-chemotherapy retroperitoneal lymph node dissection in the management of metastatic testis cancer: the 16-year experience in an Irish setting

“…This apparent contradiction did not reach statistical significance and could be due to selection bias where a proportion of Stage 4 patients continue with salvage chemotherapy without having RPLND. Also, risk factor analyses in metastatic testis cancer highlight the importance of disease bulk and elevated tumour marker status [27]. Prognosis is not governed by the presence of distal metastases alone.…”

Simultaneous Detection of Single Molecules and Singulated Ensembles of Molecules Enables Immunoassays with Broad Dynamic Range

“…PSA levels in some RP patients, however, are known to reach 100 pg/mL shortly after surgery9, so PSA levels can span four logs of concentration in one group of patients. In another example, sensitive measurements of low levels of the serum biomarkers alpha fetoprotein and β-human chorionic gonadotropin10 could be used to monitor patients for recurrence of testicular cancer after retroperitoneal lymph node dissection. Pre-surgery levels of alpha fetoprotein and β-human chorionic gonadotropin are known to span >3-logs of concentration in these patients,10 with levels dropping below the detection limit of current assays post-surgery11, suggesting clinical utility for highly sensitive assays with wide dynamic ranges.…”

“…In another example, sensitive measurements of low levels of the serum biomarkers alpha fetoprotein and β-human chorionic gonadotropin10 could be used to monitor patients for recurrence of testicular cancer after retroperitoneal lymph node dissection. Pre-surgery levels of alpha fetoprotein and β-human chorionic gonadotropin are known to span >3-logs of concentration in these patients,10 with levels dropping below the detection limit of current assays post-surgery11, suggesting clinical utility for highly sensitive assays with wide dynamic ranges. In addition, the hormone estradiol is routinely measured to assess the reproductive function in pre-menopausal women where concentration ranges in serum are greater than five logs12.…”

Testicular germ cell tumors

“…Spiess et al [27 ] attempted to identify predictors of outcome in patients with clinical stage IIa-III NSGCTs. In a retrospective analysis of 236 patients who received chemotherapy followed by retroperitoneal lymph node dissection (RPLND), a serum a-fetoprotein (AFP) greater than 9 ng/ml or human chorionic gonadotropin (HCG) greater than 4.1 mIU/ml pre-RPLND was associated with a higher risk of disease-specific death.…”