Does Receipt of Adjuvant Chemotherapy After Primary Retroperitoneal Lymph Node Dissection Affect Outcomes for Patients With Nonseminomatous Germ Cell Tumors?

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In a single-institution study reported in the Journal of Clinical Oncology, Tachibana et al found high recurrence-free survival rates among patients with pathologic stage II nonseminomatous germ cell tumors who underwent primary retroperitoneal lymph node dissection and who did not receive adjuvant chemotherapy.

As stated by the investigators, “According to National Comprehensive Cancer Network guidelines, adjuvant chemotherapy has been advocated after primary retroperitoneal lymph node dissection to reduce the risk of relapse in pathologic nodal (pN) stage pN2 or pN3, whereas surveillance is preferred for pN1. We sought to explore the oncologic efficacy of primary retroperitoneal lymph node dissection alone for pathologic stage II in nonseminomatous germ cell tumors to reduce overtreatment with chemotherapy.”

Study Details

The study involved data from a prospectively maintained database at Indiana University on patients with pathologic stage II nonseminomatous germ cell tumors who underwent primary retroperitoneal lymph node dissection between 2007 and 2017. Of a total of 117 patients with active nonseminomatous germ cell tumors in the retroperitoneum after primary retroperitoneal lymph node dissection, 7 were excluded from the current analysis due to lack of adequate follow-up, and 13 were excluded due to receipt of adjuvant chemotherapy. Among the 97 patients who received no adjuvant chemotherapy included in the analysis, nodal status was pN1 in 41, pN2 in 46, and pN3 in 10. The primary outcome measure was recurrence-free survival.

Key Findings

During a median follow-up of 52 months (IQR = 37–79 months), 20 patients (20.6%) experienced disease recurrence. Among all patients, recurrence-free survival was 80.3% at 2 years and 79% at 5 years.

Respective rates were 75.6% and 75.6% among patients with pN1 disease, 86.9% and 84.4% among those with pN2 disease, and 68.6% and 68.6% among those with pN3 disease (overall P = .49).

Lymphovascular invasion in the orchiectomy specimen along with nodal status was found to be predictive of recurrence (P < .01). On multivariate analysis controlling for nodal status, this feature remained a significant predictor of recurrence (hazard ratio = 5.92, P < .01).

All 20 patients with recurrence were treated with first-line chemotherapy and remained continuously disease-free.

The investigators concluded, “Most men with pathologic stage II disease treated with surgery alone in our series never experienced a recurrence. We did not observe a difference in recurrences between patients with pN1 and pN2. The recommendation for adjuvant chemotherapy for pN2 disease may be overtreatment in most patients.”

Isamu Tachibana, MD, of the Department of Urology, Indiana University School of Medicine, Indianapolis, is the corresponding author for the Journal of Clinical Oncology article.

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