ASCO GU 2018: Is Surveillance without Immediate Treatment an Option for Newly Diagnosed Testicular Germ-cell Cancer Patients with Borderline Size Retroperitoneal Lymph Nodes on CT Scan?

San Francisco, CA ( Dr. Nadav Milk and colleagues from Israel presented results of surveillance for patients with borderline size retroperitoneal nodes on CT scan. The AJCC TNM staging system for testicular cancer does not set a minimal diameter to define positive lymph nodes on CT scan. However, it is common to refer to lymph nodes ≥ 1 cm in diameter as positive, even though benign lymph nodes in the borderline size of 1-1.5cm are common. The objective of this study was to describe the outcome of testicular cancer patients with borderline size retroperitoneal lymph nodes of undetermined significance managed initially with surveillance.

For this study, the authors retrospectively reviewed the medical records of all testicular cancer patients treated at a single institution from 2006-2016. Demographic, clinical, laboratory, imaging, pathological, treatment and surveillance data were obtained. Analysis of associations was conducted using Fisher’s exact test for categorical variables and Student t-test for continuous variables. Kaplan-Meier survival analysis was used to calculate relapse free survival rates. 

Among 109 testicular cancer patients, 25 (22.7%) with borderline size lymph nodes were assigned to an active surveillance protocol. Median age at the time of orchiectomy was 37.2 years (IQR, 23.9-40.3). With a median follow-up of 3.9 years (IQR 1.7-6.5), overall survival rate was 100%. Nine of 25 patients (36%) relapsed and were treated within a median of 4.9 months (IQR 2.2-5.5). Median follow-up for 16 patients who did not relapse was 3.4 years (IQR 1.5-5.4). Relapse-free survival was 71% (95%CI 48-85), and 61% (95%CI 38-77) at one and two years, respectively. Orchiectomy pathology included pure seminoma in 72% of patients, and a nonseminomatous tumor in 28%. Tumor histology was not associated with likelihood of relapse (p = 0.66). The median lymph node diameter at the time of diagnosis was 11 mm (IQR 9-12, mean 10.4), and was not associated with likelihood of relapse (p = 0.34). Patients who relapsed during follow-up were significantly younger at the time of testicular cancer diagnosis than patients who did not relapse (median age 23.9 years [IQR 19.6-35.2] and 39.2 years [IQR 34.3-47.9] respectively, p = 0.0056).

The authors concluded that based on results of their single institutional study, surveillance alone for testicular cancer patients with borderline size lymph nodes of undetermined significance at diagnosis is a possible option and may help avoid over treatment in 60% of these patients.

Presented by: Nadav Milk, MD Meir Medical Center, Kfar Saba, Israel

Co-Authors:  Ilan Leibovitch, Daniel Keizman, Hadas Dresler, Itay Sternberg; Meir Medical Center, Kfar Saba, Israel; Meir Medical Center, Kfar-Saba, Israel

Written by: Zachary Klaassen, MD, Urologic Oncology Fellow, University of Toronto, Princess Margaret Cancer Centre, @zklaassen_md at the 2018 American Society of Clinical Oncology Genitourinary (ASCO GU) Cancers Symposium, February 8-10, 2018 - San Francisco, CA

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