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Outcomes of postchemotherapy retroperitoneal lymph node dissection following high‐dose chemotherapy with stem cell transplantation
Author(s) -
Cary Clint,
Pedrosa Jose A.,
Jacob Joseph,
Beck Stephen D. W.,
Rice Kevin R.,
Einhorn Lawrence H.,
Foster Richard S.
Publication year - 2015
Publication title -
cancer
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 3.052
H-Index - 304
eISSN - 1097-0142
pISSN - 0008-543X
DOI - 10.1002/cncr.29678
Subject(s) - medicine , retroperitoneal lymph node dissection , cohort , surgery , testicular cancer , proportional hazards model , teratoma , chemotherapy
BACKGROUND Characterizing the role of postchemotherapy retroperitoneal lymph node dissection (PC‐RPLND) after high‐dose chemotherapy (HDCT) has been limited by small sample sizes. This study reports on survival after HDCT with stem cell support and PC‐RPLND as well as histologic findings in the retroperitoneum. METHODS The prospectively maintained testicular cancer database of Indiana University was queried for patients receiving HDCT with stem cell transplantation before PC‐RPLND. The cause and date of death were obtained through patient chart review and contact with referring physicians. The Kaplan‐Meier method was used to evaluate overall survival (OS). The log‐rank test was used for tests of significance. A multivariate, backward, stepwise Cox regression model was built to evaluate predictors of overall mortality. RESULTS A total of 92 patients were included in the study. In the entire cohort, the retroperitoneal (RP) histology findings at the time of PC‐RPLND were necrosis (26%), teratoma (34%), and cancer (38%). Sixty‐six patients (72%) harbored either a teratoma or active cancer in the RP specimen at PC‐RPLND. The median follow‐up for the entire cohort was 80.6 months. A total of 28 patients (30%) died during follow‐up. The 5‐year OS rate of the entire cohort was 70%. The most significant predictor of death was PC‐RPLND performed in the desperation setting with elevated markers. CONCLUSIONS Despite these patients being heavily pretreated with multiple cycles of chemotherapy, including HDCT, approximately three‐fourths were found to have a teratoma and/or active cancer in the retroperitoneum. This underscores the importance of PC‐RPLND for rendering patients free of disease and providing a potential for cure. Cancer 2015;121:4369–75. © 2015 American Cancer Society .