Mp33-02 primary retroperitoneal lymph node dissection for metastatic nonseminomatous germ cell tumor: review of oncologic outcomes and the role of adjuvant chemotherapy

You have accessJournal of UrologyCME1 Apr 2023MP33-02 PRIMARY RETROPERITONEAL LYMPH NODE DISSECTION FOR METASTATIC NONSEMINOMATOUS GERM CELL TUMOR: REVIEW OF ONCOLOGIC OUTCOMES AND THE ROLE OF ADJUVANT CHEMOTHERAPY Ahmad Mousa, Lynn Anson-Cartwright, Eshetu Atenafu, Michael Jewett, Philippe Bedard, Di Maria Jiang, Rachel Glicksman, Peter Chung, Padraig Warde, Martin O'Malley, Susan Prendeville, and Robert Hamilton Ahmad MousaAhmad Mousa More articles by this author , Lynn Anson-CartwrightLynn Anson-Cartwright More articles by this author , Eshetu AtenafuEshetu Atenafu More articles by this author , Michael JewettMichael Jewett More articles by this author , Philippe BedardPhilippe Bedard More articles by this author , Di Maria JiangDi Maria Jiang More articles by this author , Rachel GlicksmanRachel Glicksman More articles by this author , Peter ChungPeter Chung More articles by this author , Padraig WardePadraig Warde More articles by this author , Martin O'MalleyMartin O'Malley More articles by this author , Susan PrendevilleSusan Prendeville More articles by this author , and Robert HamiltonRobert Hamilton More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000003266.02AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: There is renewed controversy regarding the role of adjuvant chemotherapy post primary retroperitoneal lymph node dissection (pRPLND) in the management of pathologic stage II (pN1-3) nonseminomatous germ cell tumours (NSGCT). We compared the outcomes and treatment burden of pRPLND alone versus pRPLND + adjuvant chemotherapy (AC) in this setting. METHODS: Retrospective review of the Princess Margaret Cancer Center eTestes cancer database identified men with pathologic stage II NSGCT after pRPLND between 1995-2020. The primary outcome was relapse-free survival (RFS). Secondary outcomes included disease specific survival (DSS) and burden of relapse treatment. Uni- and multivariable analyses were conducted to identify factors associated with relapse. RESULTS: A total of 109 pathologic stage II patients were included in the study. There were 96 patients treated with pRPLND alone and 13 treated with pRLND + AC (majority 2 cycles of Bleomycin, Etoposide, Cisplatin). Median follow up was 58 months. Of the 109 patients, 20 (18%) had pN1 and 89 (82%) had pN2/3 disease. The 5-year RFS was 72% for the pRPLND only group vs. 92% for the pRPLND + AC group (p=0.11). Within the pRPLND only group 5-year RFS differed by pN stage (pN1 = 94% vs. pN2/N3 = 67%, p=0.03). The presence of extra-nodal extension in the RPLND specimen was associated with relapse (HR 3.97, 95%CI 1.68-9.36, p=0.002). Despite a higher relapse rate within the pRPLND only group, DSS was similar at 5 years (98% pRPLND only vs. 100% pRPLND + AC, p=0.48). Only 24 (25%) of patients in the pRPLND only group required any chemotherapy. Extrapolating our outcomes to compare a hypothetical group of 100 patients treated with pRPLND alone to 100 with pRPLND + AC, the overall burden of chemotherapy was substantially higher in the pRPLND + AC arm (246 vs. 79 cycles). CONCLUSIONS: The majority of men with pathologic stage II NSGCT treated with pRPLND alone do not experience a recurrence or require systemic therapy. Despite a trend towards lower relapse risk when adjuvant chemotherapy is given, no difference in survival was seen but higher chemotherapy burden was entertained. Thus, AC for patients with pathologic stage II NSGCT may constitute overtreatment. Source of Funding: The Dell’Elce Family Testis Cancer Research Fund © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 209Issue Supplement 4April 2023Page: e450 Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.MetricsAuthor Information Ahmad Mousa More articles by this author Lynn Anson-Cartwright More articles by this author Eshetu Atenafu More articles by this author Michael Jewett More articles by this author Philippe Bedard More articles by this author Di Maria Jiang More articles by this author Rachel Glicksman More articles by this author Peter Chung More articles by this author Padraig Warde More articles by this author Martin O'Malley More articles by this author Susan Prendeville More articles by this author Robert Hamilton More articles by this author Expand All Advertisement PDF downloadLoading ...