To compare the outcomes and treatment burden of primary retroperitoneal lymph node dissection (pRPLND) alone versus pRPLND + adjuvant chemotherapy (AC) in patients with pathological stage II (PSII) non-seminomatous germ cell tumours (NSGCT).
Retrospective review of the Princess Margaret Cancer Center eTestes cancer database identified patients with PSII NSGCT after pRPLND between 1995 and 2020. The primary outcome was relapse-free survival (RFS). Secondary outcomes included disease-specific survival (DSS), burden of relapse treatment, and factors associated with relapse.
A total of 109 PSII patients were included in the study. There were 96 patients treated with pRPLND alone and 13 treated with pRPLND + AC. The median follow-up was 61 months. The 5-year RFS was 72% for the pRPLND-only group vs 92% for the pRPLND + AC group (hazard ratio [HR] 4.372, 95% confidence interval [CI] 0.59-32.36; P = 0.11). Within the pRPLND-only group the 5-year RFS differed by pN stage (pN1 = 94% vs pN2/N3 = 67%, P = 0.03). Despite a higher relapse rate within the pRPLND-only group, the DSS was similar at 5 years (98% pRPLND only vs 100% pRPLND + AC, P = 0.48). Only 24 (25%) of the patients in the pRPLND-only group required any subsequent chemotherapy. Despite achieving similar survival, the cumulative post-RPLND treatment burden was less for the pRPLND-only group than the pRPLND+AC group overall (average 1.23 vs 2.46 cycles of chemotherapy per patient in group).
The majority of patients with PSII NSGCT treated with pRPLND alone do not experience a recurrence or require chemotherapy. Despite a lower relapse risk when AC is given, no difference in survival was seen but higher chemotherapy burden was entertained. AC may constitute overtreatment for most patients with PSII NSGCT treated with pRPLND.
BJU international. 2024 Jul 05 [Epub ahead of print]
Ahmad Mousa, Lynn Anson-Cartwright, Eshetu G Atenafu, Michael A S Jewett, Philippe Bedard, Di Maria Jiang, Rachel Glicksman, Peter Chung, Padraig Warde, Martin O'Malley, Susan Prendeville, Robert J Hamilton
Division of Urology, Department of Surgery, University of Toronto, Toronto, Ontario, Canada., Division of Urology, Department of Surgery, Princess Margaret Cancer Centre, University of Toronto, Toronto, Ontario, Canada., Biostatistics Core, University Health Network, University of Toronto, Toronto, Ontario, Canada., Division of Medical Oncology, Department of Medicine, University of Toronto, Toronto, Ontario, Canada., Department of Radiation Oncology, University of Toronto, Toronto, Ontario, Canada., Department of Medical Imaging, University of Toronto, Toronto, Ontario, Canada., Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto, Ontario, Canada.