To reassess the role of primary retroperitoneal lymph node dissection (RPLND) in patients with marker-negative non-seminomatous germ cell tumour (NSGCT) clinical stage (CS) 2a, to explore results in patients with CS 2b and to evaluate surgical methods, recurrence, and adjuvant chemotherapy indications.
Data from 17 institutions were collected, comprising 305 men who underwent primary RPLND for CS 2 NSGCT. Regression analyses were conducted to predict histology in the RPLND specimen and disease-free survival (DFS).
A larger retroperitoneal lymph node diameter was associated with pure teratoma in the RPLND specimen (odds ratio [OR] 1.02, 95% confidence interval [CI] 1.01-1.07; P = 0.03), but no association was observed with DFS. The 5-year DFS rates in marker negative CS 2a and 2b were 79% and 76%. In men with non-teratomatous viable cancer in the RPLND specimen, the 5-year DFS rates for CS 2a and 2b were 95% and 87% with adjuvant chemotherapy, and 67% and 74% without adjuvant chemotherapy. We did not identify an association between the number of adjuvant chemotherapy cycles and DFS.
Our study suggests considering primary RPLND not only in marker-negative CS 2a but also in CS 2b. Further research should determine the efficacy of primary RPLND in men with CS 2c and marker-positive CS 2, as well as which patients may benefit from adjuvant chemotherapy and the optimal cycle number.
BJU international. 2024 Dec 11 [Epub ahead of print]
Luca Antonelli, Axel Heidenreich, Aditya Bagrodia, Armon Amini, Fady Baky, Nicolas Branger, Walter Cazzaniga, Timothy N Clinton, Siamak Daneshmand, Hooman Djaladat, Scott Eggener, Alireza Ghoreifi, Robert J Hamilton, Matthew Ho, Wade J Sexton, Sebastiano Nazzani, David Nicol, Nicola Nicolai, Kathleen Olson, Pia Paffenholz, James Porter, Zhiyu Qian, Nicholas R Rocco, Anirudh Yerrapragada, Sean P Stroup, Isamu Tachibana, Angelika Terbuch, Nirmish Singla, Clint Cary, Christian D Fankhauser, EAUâYAU Penile and Testis Cancer Working Group
Department of Urology, Luzerner Kantonsspital, University of Lucerne, Lucerne, Switzerland., Department of Urology, Uro-Oncology, Robot Assisted and Reconstructive Urologic Surgery, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany., Department of Urology, Univerity of California, San Diego, CA, USA., Department of Surgical Oncology 2, Institut Paoli-Calmettes, Marseille, France., Department of Urology, The Royal Marsden NHS Foundation Trust, London, Sutton, UK., Department of Urology, Brigham and Women's Hospital, Boston, MA, USA., Institute of Urology, Kenneth Norris Jr. Comprehensive Cancer Center, University of Southern California, Los Angeles, CA, USA., Section of Urology, Department of Surgery, University of Chicago Medical Center, Chicago, IL, USA., Division of Urology, Department of Surgery, University of Toronto, Toronto, Ontario, Canada., Department of Genitourinary Oncology, H. Lee Moffitt Cancer Center, Tampa, FL, USA., Urologic Oncology Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy., Department of Urology, Mayo Clinic, Scottsdale, AZ, USA., Department of Urology, University of Washington School of Medicine, Seattle, WA, USA., Department of Urology, Naval Medical Center, San Diego, CA, USA., Department of Urology and Oncology, The James Buchanan Brady Urological Institute, The Johns Hopkins University School of Medicine, Baltimore, MD, USA., Department of Urology, Indiana University School of Medicine, Indianapolis, IN, USA., Division of Oncology, Department of Internal Medicine, Medical University of Graz, Graz, Austria.