Pathologic findings and clinical outcome in patients undergoing retroperitoneal lymphadenectomy after multiple chemorherapy regimens for metastatic nonseminomatous testicular tumors

Abstract

We reviewed our experience with retroperitoneal lymphadenectomy (rPLa) after multiple cisplatin-based chemotherapy regimens in nonseminomatous testicular tumors (NsTT) patients and specifically evaluated clinicopathologic and treatment trend in addition to potential predictors of survival. Fort-one patients with NsTT underwent their rPLa between 1982 and 2005 after ≥ 2 regimens of chemotherapy. Thirteen patients (32%) necessitate redo-rPLa, combined with nephrectomy in 6 patients. 13 extra-rP (ErP) resections were performed in 11 patients (27%), including pulmonary (7), neck (4) and liver (2) sites. Thirty patients (73%) are rendered free of disease and 26 (63%) obtained serologic remission. Nine patients who relapse, necessitated new salvage chemotherapy+surgery (3 teratoma, 6 vital carcinoma [VC]). Four of 9 relapsing patients (44%) are currently free of disease with redorPLa. alive, free of disease are 19 pts (46%) at median follow-up of 131 months. study of rP pathology demonstrated the presence of fibrosis in 15%, teratoma in 39% and VC in 46%, with survival in 67%, 56% and 32%, respectively. different histology occurred in 38% at redo-rPLa and in 64% at ErP resection in comparison to previous rP pathology. Univariate analysis of clinicopathologic parameters associated with VC at rPLa included rP masses ≥ 5 cm (p<0.05), elevated aFP (p<0.001) or HCG (p<0.05) and ErP resection (p<0.04). On univariate analysis survival was worse in patients with rP masses ≥ 5 cm (p<0.04), elevated aFP (p<0.05) or HCG (p<0.007), ErP resection (p<0.01) and VC (p<0.004). On multivariable analysis, a rP masses ≥ 5 cm (p<0.03) and VC (p<0.005) predicted a worse ApstraktNapravljen je pregled iskustva sa retroperitonealnom limfadenektomija (rPLa), a posle brojnih hemioterapijskih ciklusa na bazi cisplatine kod pacijenata sa neseminomskim tumorima testis (NsTT) i posebno evaluirani kliničko patološki i terapeutski trendovi kao dodatak potencijalnim pokazateljima preživljava-nja. 41 pacijent sa NsTT su podvrgnuti rPLa izmedju 1982.-2005. posle ≥ 2 hemioterapijskih protokola. 13 pacijenata ( 32% ) je iziskivalo ponovnu rPLa, kombinovanu sa nefrektomijom kod 6 pacijenata. 13 ekstraretroperitonealnih resekcija je učinjeno kod 11 pacijenata (27%) uključujući pulmonalne (7), vratne (4) i jetrine (2) lokalizacije. 30 pacijenata (73%) je prevedeno u kompletnu remisiju dok je 26 (63%) imalo serološku remisiju. 9 pacijenata (32%) je imalo recidiv iziskujući novu selvage hemioterapiju i hirurgij (3 teratoma, 6 vitalni karcinom). 4 od 9 pacijenata (44%) sa recidivom je bilo bez znakova bolesti posle ponovne rPLa. živo i bez znakova bolesti je 19 pacijenata (46%) za srednje praćenje od 131 meseca. retroperitonealna histološka analiza je pokazala prisustvo fibroze kod 15%, teratoma kod 39% I vitalnog karcinom kod 46%, sa preživljavanjem kod 67%, 56%, 32% respektivno. različita histopatologija je postojala kod 38% na ponovnoj rPLa i kod 64% na ekstraretroperitonealnoj resekciji u odnosu na raniju retroperitonealnu histologiju. Nivarijantna...