No consensus exists on the management of men with nonseminoma and viable nonteratomatous germ cell tumor in the postchemotherapy retroperitoneal lymph node dissection (pcRPLND) specimen after first-line chemotherapy. We analyzed surveillance versus different adjuvant chemotherapy regimens and the influence of time to pcRPLND on oncologic outcomes.
Data on 117 men treated with cisplatin-based first-line chemotherapy between 1990 and 2018 were collected from 13 institutions. All patients had viable nonteratomatous germ cell tumor in the pcRPLND specimen. Surgery was performed after a median of 57 days, followed by either surveillance (n = 64) or adjuvant chemotherapy (n = 53). Primary end points were progression-free survival (PFS), cancer-specific survival (CSS), and overall survival (OS).
After controlling for International Germ Cell Cancer Cooperative Group risk group and percent of viable malignant cells found at RPLND, no difference was observed between men managed with surveillance or adjuvant chemotherapy regarding PFS (hazard ratio [HR], 0.72 [95% CI, 0.32 to 1.6]; P = .4), CSS (HR, 0.69; 95% CI, 0.20 to 2.39; P = .6), and OS (HR, 0.78 [95% CI, 0.25 to 2.44]; P = .7). No statistically significant differences for PFS, CSS, or OS were observed on the basis of chemotherapy regimen or in men treated with pcRPLND ≤57 versus >57 days after first-line chemotherapy. Residual disease with <10% versus ≥10% viable cancer cells were associated with a longer PFS (HR, 3.22 [95% CI, 1.29 to 8]; P = .012). Relapse in the retroperitoneum was observed in 34 (29%) men.
Men with a complete resection at pcRPLND and <10% viable cells have favorable outcomes without further treatment. Complete retroperitoneal resection seems more important than early pcRPLND.
Journal of clinical oncology : official journal of the American Society of Clinical Oncology. 2023 Sep 01 [Epub ahead of print]
Luca Antonelli, Davide Ardizzone, Isamu Tachibana, Nabil Adra, Clint Cary, Lee Hugar, Wade J Sexton, Aditya Bagrodia, Michal Mego, Siamak Daneshmand, Nicola Nicolai, Sebastiano Nazzani, Patrizia Giannatempo, Andrea Franza, Axel Heidenreich, Pia Paffenholz, Ragheed Saoud, Scott Eggener, Matthew Ho, Nathaniel Oswald, Kathleen Olson, Alexey Tryakin, Mikhail Fedyanin, Natacha Naoun, Christophe Javaud, Walter Cazzaniga, David Nicol, Axel Gerdtsson, Torgrim Tandstad, Karim Fizazi, Christian Daniel Fankhauser, EAU-YAU Penile and Testis Cancer Working Group
Department of Urology, Luzerner Kantonsspital, University of Lucerne, Lucerne, Switzerland., University of Lucerne, Lucerne, Switzerland., Department of Urology, Indiana University School of Medicine, Indianapolis, IN., Division of Medical Oncology, Indiana University School of Medicine, Indianapolis, IN., Department of Genitourinary Oncology, H. Lee Moffitt Cancer Center, Tampa, FL., Department of Urology, University of California, San Diego, CA., Department of Oncology, Comenius University, National Cancer Institute, Bratislava, Slovak Republic., Institute of Urology, Keck School of Medicine, University of Southern California, Los Angeles, CA., Urologic Oncology Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy., Department of Urology, Uro-Oncology, Robot Assisted and Reconstructive Urologic Surgery, University of Cologne, Faculty of Medicine and University of Cologne, Cologne, Germany., Section of Urology, Department of Surgery, University of Chicago Medical Center, Chicago, IL., Department of Urology, Mayo Clinic, Scottsdale, AZ., N.N. Blokhin Russian Cancer Research Center, Moscow, Russian Federation., Institut Gustave Roussy, Villejuif, France., Department of Urology, The Royal Marsden NHS Foundation Trust, London, United Kingdom., Department of Clinical Science, Intervention and Technology, Division of Urology, Karolinska Institutet, Stockholm, Sweden., The Cancer Clinic, St Olavs University Hospital, Trondheim, Norway.