There is an unmet need to avoid long-term morbidity associated with standard cytotoxic treatment for low-volume metastatic seminoma. Our aim was to assess the oncological efficacy and surgical safety of retroperitoneal lymph node dissection (RPLND) as treatment in a population-based cohort of metastatic seminoma patients with limited retroperitoneal lymphadenopathy.
Sixty-two seminoma patients in Norway and Sweden were included in the cohort from 2019 to 2022. Patients with lymphadenopathy ≤3 cm, having primary clinical stage (CS) IIA/B or CS I with a relapse, were operated with uni- or bilateral template RPLND, open or robot assisted. The outcome measures included surgical complications as per Clavien-Dindo, and Kaplan-Meier survival estimates for 24-mo progression-free survival (PFS) and overall survival (OS).
In the cohort, 33 (53%) had CS I with a relapse during surveillance, six (10%) CS I with a relapse following adjuvant chemotherapy, and 23 (37%) initial CS IIA/B. Metastatic seminoma was verified in 58 patients (94%) with a median largest diameter of 18 mm (interquartile range [IQR] 13-24). Robot-assisted RPLND was performed in 40 patients (65%). Clavien-Dindo III complications were observed in three patients (5%); no grade ≥IV complications occurred. Eighteen patients (29%) received adjuvant chemotherapy after surgery. The median follow-up was 23 mo (IQR 16-30), and recurrence occurred in six patients (10%) after a median of 8 mo (IQR 4-14). PFS was 90% (95% confidence interval: 0.86-1) and OS was 100% at 24 mo.
RPLND as primary treatment is an option for selected low-stage seminomas with a limited burden of disease, showing low complications and low relapse rates, with the potential to reduce long-term morbidity.
In seminoma patients with limited metastatic spread, surgery is a treatment option offering an alternative to chemotherapy or radiation. This paper covers the first 62 patients operated in Norway and Sweden.
European urology open science. 2024 Jun 11*** epublish ***
Anna Thor, Helene F S Negaard, Anna Grenabo Bergdahl, Bjarte Almås, Signe Melsen Larsen, Per-Olof Lundgren, Axel Gerdtsson, Dag Halvorsen, Berglind Johannsdottir, Anna K Jansson, Martin Hellström, Rolf Wahlqvist, Carl W Langberg, Annika Hedlund, Olof Akre, Ingrid Glimelius, Olof Ståhl, Hege Sagstuen Haugnes, Gabriella Cohn-Cedermark, Anders Kjellman, Torgrim Tandstad
Department of Clinical Science, Intervention and Technology, Division of Urology, Karolinska Institute, Stockholm, Sweden., Department of Oncology, Oslo University Hospital, Oslo, Norway., Department of Urology, Institute of Clinical Science, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden., Department of Urology, Haukeland University Hospital, Bergen, Norway., Department of Urology, Oslo University Hospital, Oslo, Norway., Department of Urology, St. Olavs University Hospital, Trondheim, Norway., Department of Pelvic Cancer, Genitourinary Oncology Unit, Karolinska University Hospital, Stockholm, Sweden., Department of Immunology, Genetics & Pathology, Cancer Precision Medicine, Uppsala University, Uppsala, Sweden., Department of Radiation Sciences, Oncology, Umeå University, Umeå, Sweden., The Cancer Centre, Oslo University Hospital, Oslo, Norway., Department of Oncology, Sahlgrenska University Hospital, Region Västra Götaland, Gothenburg, Sweden., Department of Urology, Pelvic Cancer, Karolinska University Hospital, Stockholm, Sweden., Department of Oncology, Skåne University Hospital, Lund, Sweden., Department of Oncology, University Hospital of North Norway, Tromsø, Norway., The Cancer Clinic, St. Olavs University Hospital, Trondheim, Norway.