SAN DIEGO, CA USA (UroToday.com) - Dr. Jonathan Silberstein and colleagues from Memorial Sloan-Kettering Cancer Center (MSKCC) looked at clinical characteristics and outcomes of patients with metastatic nonseminomatous germ cell tumor (NSGCT) in 103 patients who required re-operative retroperitoneal surgery (RORPS) following primary retroperitoneal lymph node dissection (RPLND) and post-chemotherapy (PC)-RPLND.
Univariate Cox models were used to assess the impact of the time interval between initial RPLND and RORPS, and for the histology at RORPS.
Of the 103 patients, 38 required RORPS after primary RPLND and 65 after PC-RPLND. The most common histologic finding at RORPS was teratoma (44%). Fibrosis (30%), viable GCT (15%), and malignant transformation (MT) (12%) were found less frequently. RORPS was performed within two years of initial RPLND in 58% (n= 60) of patients and teratoma was the most common histologic finding (47%, n = 45). Ten percent (n = 10) of the cohort underwent RORPS more than 15 years following initial RPLND and in these patients the most common histologic finding was MT (50%, n = 5).
The median follow-up after RORPS was 70 months. Overall probability of survival at 5-years following RORPS was 77%; 90% for RORPS following primary RPLND and 70% for RORPS following PC-RPLND. Five-year survival based on histologic findings at RORPS was 90% for patients with fibrosis, 89% for teratoma, 55% for MT, and 26% for viable non-teratomatous GCT.
Dr. Silberstein concluded that RORPS for NSGCT provided effective treatment for many high-risk patients with an overall survival rate of 77%. Teratoma was the most common finding in the setting of RORPS and these patients had significantly better prognosis than patients with MT and viable GCT.
Presented by Jonathan Silberstein, Wassim Bazzi, Emily Vertosick, Brett Carver, George Bosl, Darren Feldman, Dean Bajorin, Robert Motzer, and Joel Sheinfeld at the American Urological Association (AUA) Annual Meeting - May 4 - 8, 2013 - San Diego Convention Center - San Diego, California USA
Reported for UroToday.com by Reza Mehrazin, MD