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Lymph node count impacts survival following post‐chemotherapy retroperitoneal lymphadenectomy for non‐seminomatous testicular cancer: a population‐based analysis
Author(s) -
Bhanvadia Raj R.,
Rodriguez Joseph,
Bagrodia Aditya,
Eggener Scott E.
Publication year - 2019
Publication title -
bju international
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.773
H-Index - 148
eISSN - 1464-410X
pISSN - 1464-4096
DOI - 10.1111/bju.14798
Subject(s) - medicine , lymphadenectomy , interquartile range , proportional hazards model , oncology , testicular cancer , lymph node , survival analysis , surveillance, epidemiology, and end results , surgical oncology , cancer , gynecology , cancer registry
Objective To evaluate the prognostic significance of lymph node count ( LNC ) at post‐chemotherapy retroperitoneal lymphadenectomy ( PC ‐ RPLND ) in metastatic non‐seminomatous germ cell tumour ( NSGCT ) using the Surveillance, Epidemiology, and End Results ( SEER ) database and National Cancer Database ( NCDB ). Patients and methods SEER (2000–2013, n = 572) and NCDB (2004–2013, n = 731) identified patients undergoing PC ‐ RPLND for Stage II and III NSGCT . Correlation between linear or categorial variables and LNC was conducted using Spearman's rank correlation or Kruskal–Wallis test by ranks. Patients were stratified by ≤20, 21–40, and >40 LN s for Kaplan–Meier analysis. Cox proportional hazards models evaluated the association of LNC at PC ‐ RPLND with overall mortality ( OM ) in the NCDB and cancer‐specific mortality ( CSM ) in the SEER database . The relationship between LNC and OM or CSM was also modelled as a non‐linear function to determine a threshold for survival benefit. Results Amongst all patients, the median (interquartile range) LNC was 17 (3–26) LNs in the NCDB , and 18 (6–31) LNs in the SEER database . More recent diagnosis year, higher hospital volume, higher median income, private insurance status, and positive LNC were associated with greater total LNC in one or both databases ( P < 0.05). On Kaplan–Meier analysis, >40 LN s was associated with 5‐year cancer‐specific survival (CSS) of 99% and overall survival (OS ) of 96%, whereas ≤20 LN s had a 5‐year CSS of 91% and OS of 78% ( CSS , P = 0.04; OS , P < 0.01). Risk‐adjusted Cox model showed increasing LNC (per node) was inversely associated with OM ( hazard ratio [HR] 0.96, 95% confidence interval [CI] , 0.94–0.98; P < 0.01) and CSM ( HR 0.96, 95% CI , 0.94–0.99; P = 0.01). Non‐linear modelling showed the greatest benefit in OM at between 10 and 20 LN s, but continued survival benefit for OM and CSM beyond 20 LN s. Conclusions Greater LNC during PC ‐ RPLND appears to be associated with improved CSS and OS in NSGCT . Our data support the role of thorough RPLND for post‐chemotherapy metastatic NSGCT .