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Clinical parameters that predict histology of postchemotherapy retroperitoneal lymph node mass in testicular cancer
Author(s) -
ONOZAWA MIZUKI,
KAWAI KOJI,
YAMAMOTO TAKAHIRO,
HINOTSU SHIRO,
TSUKAMOTO SADAMU,
HATTORI KAZUNORI,
MIYANAGA NAOTO,
SHIMAZUI TORU,
AKAZA HIDEYUKI
Publication year - 2004
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/j.1442-2042.2004.00832.x
Subject(s) - seminoma , medicine , retroperitoneal lymph node dissection , testicular cancer , histology , chemotherapy , lymph node , pathology , germ cell tumors , urology , radiology
Abstract Background: Since the advent of cisplatin‐based chemotherapy, the majority of metastatic testicular cancers can be cured by chemotherapy followed by retroperitoneal lymph node dissection (RPLND). However, postchemotherapy RPLND confers no therapeutic benefit if the residual mass contains no viable cells. Therefore, to determine which parameters predict a patient's likelihood of having only necrosis in the residual mass, we retrospectively analyzed clinical parameters of patients who underwent postchemotherapy RPLND. Methods: Data from 27 patients with metastatic testicular cancer were analyzed. The histology of the primary tumor was seminoma in 11 cases and non‐seminoma in 16 cases. All of the patients with non‐seminoma showed a normalization of tumor markers after chemotherapy. Analysis of clinical parameters included data for the initial histology, pretreatment tumor marker levels, postchemotherapy retroperitoneal mass size, and the histology of the dissected RPLNs. Results: Histological examination of dissected RPLNs showed residual tumor in 27% of seminoma patients and 38% of non‐seminoma patients. In seminoma patients, no viable cells were found in all six patients with pretreatment lactate dehydrogenase (LDH) levels below 7.5 times the upper limit of normal, or in all five of the patients with postchemotherapy RPLNs less than 2.5 cm. In non‐seminoma patients, no viable cells were found in nine of 10 patients with pretreatment alpha‐fetoprotein (AFP) levels less than 2700 ng/mL, or in eight of nine patients with residual mass less than 2.5 cm. Conclusions: Both postchemotherapy RPLN mass size and pretreatment tumor marker levels are possible predictors for necrosis of the residual mass in testicular cancer patients.