Analysis of Patients Who Have Undergone Retroperitoneal Lymph Node Dissection and Metastasectomy after Chemotherapy for Advanced Nonseminomatous Germ Cell Tumors: A Retrospective Study
Authors/Creators
- 1. Assistant Professor, Department of Urology, AIIMS Patna, Bihar, India
- 2. MD Medical Officer, Department of Microbiology, Sub Divisional Hospital, Bihar, India
- 3. Assistant Professor, Department of Medicine, BMIMS, Pawapuri, Bihar, India
Description
Background: Testicular tumors are rare, with germ cell tumors being a significant subset. Advances in treatment have improved survival rates, but determining the appropriate course of action for advanced nonseminomatous germ cell tumors (NSGCT) remains crucial. Post-chemotherapy retroperitoneal lymph node dissection (PC-RPLND) may lead to unnecessary chemotherapy. This study aims to link histological findings with necrosis indicators. Methodology: This retrospective analysis involved reviewing pre- and post-chemo data, histologies, and tumor indicators from hospitals. 90 PC-RPLND and 20 metastasectomy patients were included. Statistical analysis, including univariate methods, assessed variables with SPSS software (P < 0.05). Receiver operating curves identified predictors. Results: Among 90 PC-RPLND patients, 55.5% had Stage III NSGCT, commonly metastasizing to lungs and liver. PC-RPLND histology showed 45.83% necrosis, 9.7% viable tumor, and 44.44% teratoma-only histology. In 20 metastasectomy cases, RPLND and metastasectomy histology matched by 84.6%, and orchidectomy and metastasectomy matched by 69.2%. Nodal size change predicted necrosis with 100% specificity at 75% reduction. Recommendation: This study on advanced-stage NSGCT provides insights into clinical management and histological complexities. Patients received standardized chemotherapy, and responses were evaluated through nodal size changes. Concordance between RPLND and metastasectomy histology enhances understanding. Conclusion: This analysis of PC-RPLND and metastasectomy cases offers insights into advanced-stage NSGCT management. Meticulous data collection enables nuanced exploration, potentially improving future patient outcomes.
Abstract (English)
Background: Testicular tumors are rare, with germ cell tumors being a significant subset. Advances in treatment have improved survival rates, but determining the appropriate course of action for advanced nonseminomatous germ cell tumors (NSGCT) remains crucial. Post-chemotherapy retroperitoneal lymph node dissection (PC-RPLND) may lead to unnecessary chemotherapy. This study aims to link histological findings with necrosis indicators. Methodology: This retrospective analysis involved reviewing pre- and post-chemo data, histologies, and tumor indicators from hospitals. 90 PC-RPLND and 20 metastasectomy patients were included. Statistical analysis, including univariate methods, assessed variables with SPSS software (P < 0.05). Receiver operating curves identified predictors. Results: Among 90 PC-RPLND patients, 55.5% had Stage III NSGCT, commonly metastasizing to lungs and liver. PC-RPLND histology showed 45.83% necrosis, 9.7% viable tumor, and 44.44% teratoma-only histology. In 20 metastasectomy cases, RPLND and metastasectomy histology matched by 84.6%, and orchidectomy and metastasectomy matched by 69.2%. Nodal size change predicted necrosis with 100% specificity at 75% reduction. Recommendation: This study on advanced-stage NSGCT provides insights into clinical management and histological complexities. Patients received standardized chemotherapy, and responses were evaluated through nodal size changes. Concordance between RPLND and metastasectomy histology enhances understanding. Conclusion: This analysis of PC-RPLND and metastasectomy cases offers insights into advanced-stage NSGCT management. Meticulous data collection enables nuanced exploration, potentially improving future patient outcomes.
Files
IJPCR,Vol15,Issue12,Article301.pdf
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Additional details
Dates
- Accepted
-
2023-12-10
Software
- Repository URL
- https://impactfactor.org/PDF/IJPCR/15/IJPCR,Vol15,Issue12,Article301.pdf
- Development Status
- Active
References
- 1. Stephenson AJ, Gilligan TD. Neoplasms of the testis. Campbell-Walsh Urology. 2012:837-70. 2. Stone JM, Sandeman TF, Ironside P, Cruickshank DG, Matthews JP. Time trends in accuracy of classification of testicular tumours, with clinical and epidemiological implications. British journal of cancer. 1992 Aug;66(2):396- 401. 3. Dieckmann KP, Pichlmeier U. Clinical epidemiology of testicular germ cell tumors. World journal of urology. 2004 Apr; 22:2-14. 4. Wilkinson PM, Read G. International Germ Cell Consensus Classification: a prognostic factor-based staging system for metastatic germ cell cancers. International Germ Cell Cancer Collaborative Group. 5. Motzer RJ, Agarwal N, Beard C, Bolger GB, Boston B, Carducci MA, Choueiri TK, Figlin RA, Fishman M, Hancock SL, Hudes GR. NCCN clinical practice guidelines in oncology: testicular cancer. Journal of the National Comprehensive Cancer Network: JNCCN. 2009 Jun;7(6):672-93. 6. Steyerberg E, Keizer HJ, Fossa S, Sleijfer D, Toner GC, Schraffordt Koops H, Mulders PF, Ney K, Donohue JP. Prediction of residual retroperitoneal mass histology after chemotherapy for metastatic nonseminomatous germ cell tumor: multivariate analysis of individual patient data from six study groups. Journal of clinical oncology. 1995 May 1;13(5):1177-87. 7. Fox EP, Weathers TD, Williams SD, Loehrer PJ, Ulbright TM, Donohue JP, Einhorn LH. Outcome analysis for patients with persistent nonteratomatous germ cell tumor in postchemotherapy retroperitoneal lymph node dissections. Journal of clinical oncology. 1993 Jul;11(7):1294-9. 8. Steyerberg EW, Keizer HJ, Messemer JE, Toner GC, Koops HS, Fosså SD, Gerl A, Sleijfer DT, Donohue JP, Habbema JD, ReHiT Study Group. Residual pulmonary masses after chemotherapy for metastatic nonseminomatous germ cell tumor: prediction of histology. Cancer. 1997 Jan 15;79(2):345-55. 9. Nakamura T, Oishi M, Ueda T, Fujihara A, Nakanishi H, Kamoi K, Naya Y, Hongo F, Okihara K, Miki T. Clinical outcomes and histological findings of patients with advanced metastatic germ cell tumors undergoing post‐ chemotherapy resection of retroperitoneal lymph nodes and residual extraretroperitoneal masses. International Journal of Urology. 2015 Jul;22(7):663-8