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Results and Outcome of Retroperitoneal Lymph Node Dissection for Clinical Stage I Embryonal Carcinoma–Predominant Testis Cancer

From the Department of Medicine, Division of Hematology/Oncology; Department of Urology; and Department of Medicine, Division of Biostatistics, Indiana University Medical Center, Indianapolis, IN.

Address reprint requests to Lawrence H. Einhorn, MD, Indiana University, Indiana Cancer Pavilion, 535 Barnhill Dr, Room 473, Indianapolis, IN 46202; email chsweene{at}iupui

PURPOSE: To determine the incidence of metastatic disease and usage of chemotherapy (adjuvant or metastatic) after primary retroperitoneal lymph node dissection (RPLND) in patients with clinical stage (CS) I embryonal carcinoma (EC)–predominant testicular cancer. EC predominance was defined as the presence of EC at a level greater than that of any other histologic diagonsis.

PATIENTS AND METHODS: All CS I patients with nonseminomatous germ cell tumors who underwent RPLND at Indiana University from 1990 to 1995 were reviewed retrospectively.

RESULTS: Two-year follow-up was available for 292 of 320 patients. EC-predominant disease was found in 125 (42.8%) of 292. Eighty-five (68.0%) of 125 patients with EC-predominant disease had pathologic stage (PS) I, and 18 (21.2%) of this group of 85 relapsed. A significantly lower PS I relapse rate of 3% was found for patients who had non–EC-predominant disease (P < .0001). PS II disease was more frequent in patients with EC predominance, as 40 (32.0%) of 125 had retroperitoneal metastases, compared with 26 (15.6%) of 167 patients with a non–EC-predominant histologic diagnosis (P = .0024). Chemotherapy was administered to 48 (38.4%) of the 125 patients with CS I EC-predominant disease after RPLND. This included 25 CS I patients with PS II disease who received adjuvant chemotherapy in addition to 23 patients who subsequently required chemotherapy for relapse after RPLND. Ten (66.6%) of 15 PS II EC-predominant patients were cured by surgery alone. Currently, all 125 EC-predominant patients are disease-free.

CONCLUSION: Patients with CS I EC-predominant disease are at a relatively high risk for metastatic disease.

Presented in part at the Thirty-Fourth Annual Meeting of the American Society of Clinical Oncology, Los Angeles, CA, May 16-19, 1998.

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