Primary retroperitoneal lymph node dissection for metastatic non-seminomatous germ cell tumours: outcomes and adjuvant chemotherapy.
adjuvant chemotherapy
non‐seminoma
primary retroperitoneal lymph node dissection
surveillance
testicular cancer
Journal
BJU international
ISSN: 1464-410X
Titre abrégé: BJU Int
Pays: England
ID NLM: 100886721
Informations de publication
Date de publication:
05 Jul 2024
05 Jul 2024
Historique:
medline:
5
7
2024
pubmed:
5
7
2024
entrez:
5
7
2024
Statut:
aheadofprint
Résumé
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.
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Subventions
Organisme : Dell'Elce Family Testis Cancer Research Fund
Informations de copyright
© 2024 The Author(s). BJU International published by John Wiley & Sons Ltd on behalf of BJU International.
Références
National Comprehensive Cancer Network Testicular Cancer Guidelines (Version 1.2023). 2023 Nccnorg. https://www.nccn.org/professionals/physician_gls/pdf/testicular.pdf. Accessed January 2024
Ghosh S. Cisplatin: the first metal based anticancer drug. Bioorg Chem 2019; 88: 102925
Gurjal A, An T, Valdivieso M, Kalemkerian GP. Etoposide‐induced pulmonary toxicity. Lung Cancer 1999; 26: 109–112
Kobayashi K, Ratain MJ. Pharmacodynamics and long‐term toxicity of etoposide. Cancer Chemother Pharmacol 1994; 34(Suppl): S64–S68
Tachibana I, Kern SQ, Douglawi A et al. Primary retroperitoneal lymph node dissection for patients with pathologic stage II nonseminomatous germ cell tumor‐N1, N2, and N3 disease: is adjuvant chemotherapy necessary? J Clin Oncol 2022; 40: 3762–3769
Douglawi A, Calaway A, Tachibana I et al. Long‐term oncologic outcomes after primary retroperitoneal lymph node dissection: minimizing the need for adjuvant chemotherapy. J Urol 2020; 204: 96–103
Neuenschwander A, Lonati C, Antonelli L et al. Treatment outcomes for men with clinical stage II nonseminomatous germ cell tumours treated with primary retroperitoneal lymph node dissection: a systematic review. Eur Urol Focus 2023; 9: 541–546
Donohue JP, Thornhill JA, Foster RS, Bihrle R, Rowland RG, Einhorn LH. The role of retroperitoneal lymphadenectomy in clinical stage B testis cancer: the Indiana University experience (1965 to 1989). J Urol 1995; 153: 85–89
Al‐Ahmadie HA, Carver BS, Cronin AM et al. Primary retroperitoneal lymph node dissection in low‐stage testicular germ cell tumors: a detailed pathologic study with clinical outcome analysis with special emphasis on patients who did not receive adjuvant therapy. Urology 2013; 82: 1341–1346
Nayan M, Jewett MAS, Sweet J et al. Lymph node yield in primary retroperitoneal lymph node dissection for nonseminoma germ cell tumors. J Urol 2015; 194: 386–391
McHugh DJ, Funt SA, Silber D et al. Adjuvant chemotherapy with etoposide plus cisplatin for patients with pathologic stage II nonseminomatous germ cell tumors. J Clin Oncol 2020; 38: 1332–1337
Nelson JB, Chen RN, Bishoff JT et al. Laparoscopic retroperitoneal lymph node dissection for clinical stage I nonseminomatous germ cell testicular tumors. Urology 1999; 54: 1064–1067
Neyer M, Peschel R, Akkad T et al. Long‐term results of laparoscopic retroperitoneal lymph‐node dissection for clinical stage I nonseminomatous germ‐cell testicular cancer. J Endourol 2007; 21: 180–183
Cresswell J, Scheitlin W, Gozen A, Lenz E, Teber D, Rassweiler J. Laparoscopic retroperitoneal lymph node dissection combined with adjuvant chemotherapy for pathological stage II disease in nonseminomatous germ cell tumours: a 15‐year experience. BJU Int 2008; 102: 844–848
Nicolai N, Tarabelloni N, Gasperoni F et al. Laparoscopic retroperitoneal lymph node dissection for clinical stage I nonseminomatous germ cell tumors of the testis: safety and efficacy analyses at a high volume center. J Urol 2018; 199: 741–747
Pearce SM, Golan S, Gorin MA et al. Safety and early oncologic effectiveness of primary robotic retroperitoneal lymph node dissection for nonseminomatous germ cell testicular cancer. Eur Urol 2017; 71: 476–482
Rocco NR, Stroup SP, Abdul‐Muhsin HM. Primary robotic RLPND for nonseminomatous germ cell testicular cancer: a two‐center analysis ofintermediate oncologic and safety outcomes. World J Urol 2020; 38: 859–867
Stephenson A, Eggener SE, Bass EB et al. Diagnosis and treatment of early stage testicular cancer: AUA guideline. J Urol 2019; 202: 272–281
Albers P, Albrecht W, Algaba F et al. Guidelines on testicular cancer: 2015 update. Eur Urol 2015; 68: 1054–1068
Williams SD, Stablein DM, Einhorn LH. Immediate adjuvant chemotherapy versus observation with treatment at relapse in patho‐ logical stage II testicular cancer. N Engl J Med 1987; 317: 1433–1438
Weissbach L, Bussar‐Maatz R, Flechtner H, Pichlmeier U, Hartmann M, Keller L. RPLND or primary chemotherapy in clinical stage IIA/B nonseminomatous germ cell tumors? Eur Urol 2000; 37: 582–594
Logothetis C, Swanson D, Dexeus F et al. Primary chemotherapy for clinical stage II nonseminomatous germ cell tumors of the testis: a follow‐up of 50 patients. J Clin Oncol 1987; 5: 906–911
Culine S, Kerbrat P, Kramar A et al. Refining the optimal chemotherapy regimen for good‐risk metastatic nonseminomatous germ‐cell tumors: a randomized trial of the Genito‐urinary Group of the French Federation of cancer centers (GETUG T93BP). Ann Oncol 2007; 18: 917–924
Kuczyk M, Machtens S, Stief C, Jonas U. Management of the post‐chemotherapy residual mass in patients with advanced stage non‐seminomatous germ cell tumors (NSGCT). Int J Cancer 1999; 83: 852–855
Albers P, Albers J, Cummings OW, Boris M, Donohue JP, Foster RS. Flow cytometric and cytophotometric DNA analysis cannot predict subsequent tumour recurrence in pathological stage IIA/B non‐seminomatous testicular germ cell tumour patients who do not receive adjuvant chemotherapy. Eur J Cancer 1995; 31A: 848–849
Sesterhenn IA, Weiss RB, Mostofi FK et al. Prognosis and other clinical correlates of pathologic review in stage I and II testicular carcinoma: a report from the testicular cancer intergroup study. J Clin Oncol 1992; 10: 69–78
Vugrin D, Whitmore WF, Cvitkovic E et al. Adjuvant chemotherapy combination of vinblastine, actinomycin D, bleomycin, and chlorambucil following retroperitoneal lymph node dissection for stage II testis tumor. Cancer 1981; 47: 840–844
Beck SDW, Cheng L, Bihrle R, Donohue JP, Foster RS. Does the presence of extranodal extension in pathological stage B1 nonseminomatous germ cell tumor necessitate adjuvant chemotherapy? J Urol 2007; 177: 944–946
von der Maase H, Specht L, Jacobsen GK et al. Surveillance following orchidectomy for stage I seminoma of the testis. Eur J Cancer 1993; 29A: 1931–1934
Warde PR, Gospodarowicz MK, Goodman PJ et al. Results of a policy of surveillance in stage I testicular seminoma. Int J Radiat Oncol Biol Phys 1993; 27: 11–15