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Results of retroperitoneal lymph node dissection after chemotherapy in patients with pure seminoma in the orchidectomy specimen but elevated serum α‐fetoprotein
Author(s) -
Peterson Matthew,
Beck Stephen,
Bihrle Richard,
Einhorn Lawrence,
Foster Richard
Publication year - 2009
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/j.1464-410x.2009.08697.x
Subject(s) - seminoma , retroperitoneal lymph node dissection , medicine , yolk sac , testicular cancer , chemotherapy , teratoma , germ cell tumors , dissection (medical) , cancer , urology , pathology , surgery , biology , embryo , microbiology and biotechnology
OBJECTIVE To determine the incidence of necrosis, teratoma, and active cancer in specimens at retroperitoneal lymph node dissection (RPLND) after chemotherapy in patients who presented with a pure seminoma primary tumour and an elevated serum α‐fetoprotein (AFP) level at diagnosis who underwent surgery. PATIENTS AND METHODS A retrospective review of the Indiana University testis cancer database from 1980 to 2004 was performed to identify all patients with metastasic germ cell cancer, pure seminoma in the orchidectomy specimen, and an elevated AFP level. In all, 42 patients were identified; two with nonseminomatous germ cell cancer in the contralateral testicle were excluded. RESULTS RPLND pathology in the 40 patients showed necrosis in 13 (32.5%), teratoma in 12 (30%), and cancer in 15 (37.5%). The histological subtype of the 15 cancer specimens at RPLND was pure seminoma in two, embryonal in three, yolk sac in seven, variant in one, and mixed elements in two (one with seminoma and yolk sac, and one with embryonal and variant). In all, 20 patients presented with a serum AFP level of <1000 µg/mL with nine (45%) having teratoma only in the retroperitoneum in contrast to 20 patients with an AFP level of >1000 µg/mL with three (15%) having teratoma only in the retroperitoneum ( P = 0.04). The level of serum AFP did not predict for active cancer in the retroperitoneum ( P = 0.5). CONCLUSIONS RPLND in patients after chemotherapy who presented with pure seminoma in the orchidectomy specimen and an elevated AFP do not have a high probability of finding necrosis only in the RPLND specimen. In fact, the prevalence of persistent cancer is higher compared with the general group of patients that have RPLND after chemotherapy.