To characterize clinical and pathologic outcomes of cisplatin-refractory or relapsed germ cell tumor (GCT) patients who underwent retroperitoneal lymph node dissection (RPLND) following salvage chemotherapy with either conventional or high dose regimens.
Data was reviewed to identify all patients treated with TIP or TICE salvage chemotherapy between 1994 and 2011(n=184) at our institution. We report clinicopathologic and outcomes data on 131 patients who were further managed with surgical resection. Using Cox-proportional hazards models, predictors of disease-specific survival (DSS) were analyzed.
Median follow-up was 7.3 years. Of the 112 patients who underwent post-salvage chemotherapy RPLND, histology was reported as viable GCT in 30 (27%), teratoma only in 26 (23%) and fibrosis in 56 (50%). 5-yr DSS for the entire cohort was 74% (95% CI 63% -80%). On multivariable analysis, viable GCT histology at RPLND or extra-RPLND resection predicted for worse DSS (HR 7.37, p=0.003).
Our data suggests that approximately half of the patient with cisplatin-refractory or relapsed GCT salvaged with TIP or TICE chemotherapy and evidence of residual disease are at risk of harboring either viable GCT or teratoma. This finding underlines the critical role of surgery in the multimodality approach to the management of this advanced disease entity. If retroperitoneal disease exists prior to salvage chemotherapy, we recommend post-chemotherapy resection in all eligible patients.
Urology. 2018 Oct 05 [Epub ahead of print]
Mariam Imnadze Miller, Andrew Feifer, Darren R Feldman, Brett S Carver, George J Bosl, Robert J Motzer, Dean F Bajorin, Joel Sheinfeld
Urology Service, Department of Surgery, Sidney Kimmel Center for Prostate and Urological Cancers, Memorial Sloan Kettering Cancer Center, New York, NY. Electronic address: ., Urology Service, Department of Surgery, Sidney Kimmel Center for Prostate and Urological Cancers, Memorial Sloan Kettering Cancer Center, New York, NY., Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY.