Presentation Authors: Antoin Douglawi*, Adam Calaway, Isamu Tachibana, Marcelo Barboza, Timothy Masterson, Richard Foster, Clint Cary, Indianapolis, IN
Introduction: Primary Retroperitoenal Lymph Node Dissection (RPLND) is a management option for men with Clinical Stage I or low-volume Clinical Stage II non-seminomatous germ cell tumors (NSGCT). We sought to analyze the oncological outcomes of men undergoing primary RPLND at our institution over the last decade to better characterize the use of template dissections and adjuvant chemotherapy.
Methods: A retrospective review of the Indiana University testis cancer database identified patients who underwent open RPLND for NSGCT from 01/2007 to 12/2017. Patients and referring providers were contacted to obtain information regarding receipt of adjuvant therapy, recurrence and vital status. Those who could not be contacted were excluded. Recurrence rates were compared between numerous demographic and clinical variables. Kaplan-Meier curves were constructed to assess differences in recurrence-free survival (RFS) between pathological stage and use of adjuvant chemotherapy use. Differences between the curves were assessed using the logrank test.
Results: Recurrence and survival data was obtained for 87% of identified patients. After exclusion criteria, 268 patients were included in the study. The median age at presentation was 28 (IQR 23-35) and most men presented with Clinical Stage I disease (210, 78.6%). The template of dissection was modified unilateral in 248 (92.5%) and bilateral in 20 (7.5%). Overall, 142 (53%) and 126 (47%) of men had pathologic stage I and stage II disease, respectively. Eighteen patients (14.2%) with pathologic stage II disease were treated with adjuvant chemotherapy. With a median follow-up of 53 months, only 30 (11.1%) patients recurred (median RFS: 4.5 months). Of the 108 patients with Pathologic Stage II disease who did not receive chemotherapy, 18 (16.7%) patients relapsed. There were no differences in recurrences among patients who had modified or bilateral template approach (p=0.37). RFS curves stratified by pathologic stage/adjuvant chemotherapy receipt are shown in Figure 1. Of 6 patients deceased, only 2 died from testis cancer.
Conclusions: The use of adjuvant chemotherapy has been minimal over the past decade in the setting of a tertiary care center. A significant majority of patients with pathologic stage II disease do not recur following RPLND alone.