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Advanced germ cell tumor patients undergoing post‐chemotherapy retroperitoneal lymph node dissection: Impact of residual teratoma on prognosis
Author(s) -
Nitta Satoshi,
Kawai Koji,
Kimura Tomokazu,
Kandori Shuya,
Kawahara Takashi,
Kojima Takahiro,
Nishiyama Hiroyuki
Publication year - 2021
Publication title -
international journal of urology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.172
H-Index - 67
eISSN - 1442-2042
pISSN - 0919-8172
DOI - 10.1111/iju.14587
Subject(s) - medicine , retroperitoneal lymph node dissection , teratoma , germ cell tumors , lymph node , chemotherapy , dissection (medical) , malignancy , radiology , surgery , pathology , testicular cancer
Objectives To evaluate the histologic findings and clinical outcomes of post‐chemotherapy retroperitoneal lymph node dissection for advanced germ cell tumor. Methods We analyzed the medical records of 66 patients who underwent post‐chemotherapy retroperitoneal lymph node dissection between 2005 and 2019 at Tsukuba University Hospital. Results The proportions of necrosis, teratoma, and viable germ cell tumor in the specimens were 62.1%, 36.4%, and 1.5%, respectively. The 5‐year progression‐free and overall survival rates were 82.3% and 91.3%, respectively. The 5‐year overall survival rate of patients with residual teratoma was significantly worse than that of patients with necrosis only (74.1% vs 100%). Overall, three patients died: one from cancer and two from teratoma with somatic‐type malignancy. Of these, two patients relapsed after incomplete resection of residual teratoma. When limited to patients with completely resected teratoma, the 5‐year overall survival rate was 91.7%, which did not differ from that for patients with necrosis only. Multivariate analysis showed that presence of teratoma in the primary site and decrease in retroperitoneal lymph node mass to less than 50% of the initial tumor size were independent factors for residual teratoma. However, the absence of these factors could not reliably predict necrosis only in retroperitoneal lymph node dissection specimens. Conclusions In our series, 98% of post‐chemotherapy retroperitoneal lymph node dissection pathology was either necrosis or teratoma, with viable germ cell tumor only found in 2% of patients. Residual teratoma was associated with poorer prognosis, especially in cases of incomplete resection.