Long‐term outcome for men with teratoma found at postchemotherapy retroperitoneal lymph node dissection

Abstract

BACKGROUND:Patients with pure teratoma within the postchemotherapy retroperitoneal lymph node dissection (PC‐RPLND) specimen traditionally have been considered at low risk for disease progression. The objectives of this study were to determine the disease‐related outcomes of patients who had pure teratoma identified at the time of PC‐RPLND and to examine the prognostic value of clinical variables that were identified previously as important predictors of disease recurrence in these patients.METHODS:Between 1980 and 2003, 97 patients with metastatic nonseminomatous germ cell tumor and pure teratoma histology at the time of PC‐RPLND were identified. The medical records of these patients were reviewed retrospectively for pertinent clinical and treatment‐related outcomes.RESULTS:At a median follow‐up of 7.4 years, 21 patients (22%) developed recurrent disease after PC‐RPLND. The 5‐year and 10‐year probabilities (±standard error) of freedom from disease recurrence were 81% ± 4% and 76% ± 5%, respectively. The postchemotherapy α‐fetoprotein (AFP) level and mediastinal involvement at presentation were statistically significant predictors of disease recurrence on multivariate analysis. Nine of 97 patients (9.3%) died from testis cancer, and 4 patients died from other causes.CONCLUSIONS:In patients with pure teratoma histology at PC‐RPLND, mediastinal involvement at presentation and the presence of an elevated AFP level before PC‐RPLND predicted an unfavorable outcome. The absence of mediastinal involvement and normal AFP level, however, did not confirm freedom from disease recurrence. Patients who had teratoma at the time of PC‐RPLND remained at considerable risk for disease progression because of the unpredictable nature of teratoma and the presence of unrecognized, active germ cell disease outside the retroperitoneum. Cancer 2009. © 2009 American Cancer Society.

Teratoma identified after postchemotherapy retroperitoneal lymphadenectomy

“…Similarly, 9 of 97 patients (9.3%) in the Svatek et al 12 series died of disease. Loehrer et al 4 also observed that 8 of 51 patients (15.7%) with teratoma at PC-RPLA died.…”

“…Ten of those 30 patients (14%) who had developed disease recurrence with MT/IMT, 5 (17%) with TMT, and 15 (50%) had viable GCT. Svatek et al 12 identi ed disease recurrence in 21 of 97 patients (22%), including 8 recurrences with viable GCT.…”

“…Svatek et al 12 reported that patiens with mediastinal site at presentation or an elevated serum AFP before PC-RPLA were at higher risk for disease recurrence. Our study demonstrated that patients with worse IGCCCG risk classi cation and those with larger retroperitoneal residual mass ( >5cm) are at higher risk of relapse (probability of freedom for recurrence were 87%, 67% and 94%, 91% and 59%, respectively).…”

Management of Non-Seminomatous Germ Cell Tumor of the Testis

“…Other authors have had similar results. Loehrer et al, 1986;Svatek et al, 2009) Investigators from Indiana University recently reported recurrence rates after resection of large volume (> 10 cm) teratoma. (S. D.W. Beck, Foster, Bihrle, Donohue, & Einhorn, 2007) The 2 and 5-year recurrence free survival for the 99 patients was 86% and 75%, with a mean follow up of 42 months, suggesting that in large volume masses, recurrence rates are also noteworthy.…”

Clinical Outcome of Patients with Fibrosis/Necrosis at Post-Chemotherapy Retroperitoneal Lymph Node Dissection for Advanced Germ Cell Tumors

“…While previous studies have reported clinicopathological characteristics of patients with viable GCT and teratoma at post-chemotherapy RPLND, 10–12 less is known regarding patients with findings of fibrosis. In the current study, we aimed to characterize patients with a finding of necrosis/fibrosis at PC-RPLND, and identify predictors of adverse outcome within this group of patients.…”