In a retrospective study reported in the Journal of Clinical Oncology, Antonelli et al found no difference in outcomes with postsurgical surveillance vs adjuvant chemotherapy after retroperitoneal lymph node dissection (RPLND) showed viable nonteratomatous germ cell tumor in patients who had received first-line chemotherapy for nonseminoma testicular cancer.
Study Details
The international study involved data from 117 patients treated with cisplatin-based first-line chemotherapy between 1990 and 2018 at 13 institutions. All patients had viable nonteratomatous germ cell tumor detected in their postchemotherapy RPLND specimen. Surgery was performed after a median of 57 days, followed by surveillance (n = 64) or adjuvant chemotherapy (n = 53). Major outcome measures were progression-free survival, cancer-specific survival, and overall survival.
Key Findings
In an analysis controlling for International Germ Cell Cancer Cooperative Group risk group and percent of viable malignant cells at RPLND, no difference was observed in the following endpoints between patients who underwent surveillance vs those who received adjuvant chemotherapy:
- 5-year progression-free survival (50% vs 53%, hazard ratio [HR] = 0.72, 95% confidence interval [CI] = 0.32–1.6, P =.4)
- 5-year cancer-specific survival (77% vs 70%, HR = 0.69, 95% CI = 0.20–2.39, P = .6)
- 5-year overall survival (73% vs 69%, HR = 0.78, 95% CI = 0.25–2.44, P = .7).
Surgery led to complete resection and negative surgical margins in 91% and 95% of patients undergoing surveillance after postchemotherapy RPLND and in 92% and 91% of those receiving adjuvant chemotherapy after postchemotherapy RPLND. No statistically significant differences in progression-free, cancer-specific, or overall survival were observed according to adjuvant chemotherapy regimen received or according to receipt of postchemotherapy RPLND at 57 or fewer vs more than 57 days after first-line chemotherapy.
Among all patients, residual disease with < 10% vs ≥ 10% viable cancer cells was associated with significantly improved progression-free survival (HR = 3.22, 95% CI = 1.29–8.0, P = .012).
The investigators concluded: “Men with a complete resection at postchemotherapy RPLND and < 10% viable cells have favorable outcomes without further treatment. Complete retroperitoneal resection seems more important than early postchemotherapy RPLND.”
Christian Daniel Fankhauser, MD, of the University of Zurich, is the corresponding author of the Journal of Clinical Oncology article.
Disclosure: For full disclosures of the study authors, visit ascopubs.org.
