Association of Lymph Node Count and Survival After Primary Retroperitoneal Lymphadenectomy for Non-Seminomatous Testicular Cancer.

Retroperitoneal lymph node dissection (RPLND) for men with clinical stage (CS) I or II testicular nonseminomatous germ cell tumors (NSGCT) has both staging and therapeutic implications. We aim to investigate the impact of lymph node count (LNC) on outcome after primary RPLND for men with CS I or II NSGCT using a nationally representative dataset.

A retrospective analysis of men who received a primary RPLND for CS I or II NSGCT was performed using the National Cancer Database. The Kaplan-Meier method was used to determine overall survival (OS), according to LNC. Logistic regression analyses were used to identify factors associated with LNC >20 and factors predictive of lymph node positive (pN+) disease after primary RPLND.

Of 1,376 men who comprised our analytic cohort, 50.1% and 49.9% had 1-20 LNs and >20 LNs removed, respectively. Five-year OS rates were 96.4% and 99.1% for men with 1-20 and >20 LNs resected, respectively (p=0.004). A higher proportion of men with >20 LNs removed were treated at academic centers, had private insurance, presented with higher AJCC clinical stage, and were more likely to have pN+ disease, when compared to those with 1-20 LNs removed. Factors significantly associated with pN+ disease after RPLND include higher AJCC clinical stage and LNC (per 10 count increase).

Higher LNC after primary RPLND significantly increases the likelihood of identifying pN+ disease and is associated with improved overall survival. Our data supports the therapeutic implications of a thoroughly performed RPLND in the primary setting.

The Journal of urology. 2022 Jan 03 [Epub ahead of print]

Hiren V Patel, Arnav Srivastava, Sinae Kim, Hiten D Patel, Phillip M Pierorazio, Aditya Bagrodia, Timothy A Masterson, Saum B Ghodoussipour, Isaac Y Kim, Eric A Singer, Thomas L Jang

Section of Urologic Oncology, Rutgers Cancer Institute of New Jersey and Rutgers Robert Wood Johnson Medical School, New Brunswick, New Jersey., Department of Biostatistics and Epidemiology, School of Public Health, Rutgers University, Piscataway, New Jersey., Department of Urology, Loyola University Medical Center, Maywood, Illinois., The James Buchanan Brady Urologic Institute and Department of Urology, The Johns Hopkins University School of Medicine, Baltimore, Maryl., Department of Urology, University of Texas Southwestern, Dallas, Texas., Department of Urology, Indiana University School of Medicine, Indianapolis, Indiana.

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