Oncologic outcomes of retroperitoneal lymph node dissection following first-line chemotherapy for metastatic non-seminomatous germ-cell tumors

IF 56.7 1区医学 Q1 ONCOLOGY

Annals of Oncology Pub Date : 2025-03-10 DOI:10.1016/j.annonc.2025.03.002

R.S. Matulewicz , F. Baky , N. Liso , B.M. Williams , S. Porwal , M. Assel , B.S. Carver , D.F. Bajorin , R.J. Motzer , G.J. Bosl , D.J. McHugh , V.E. Reuter , S.K. Tickoo , H. Al-Ahmadie , A.J. Vickers , S.A. Funt , D.R. Feldman , J. Sheinfeld

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引用次数: 0

Abstract

Background

Post-chemotherapy retroperitoneal lymph node dissection (pcRPLND) is integral to multimodal treatment of patients with metastatic non-seminomatous germ-cell tumors (NSGCT). We review pathologic and long-term outcomes of pcRPLND following first-line chemotherapy with a focus on residual mass size and primary tumor histology. Our goal was to identify new predictive approaches that can refine surgical indications.

Patients and methods

Patients who underwent pcRPLND for NSGCT at our institution between 1 January 2000 and 18 January 2023 following first-line chemotherapy were included. The primary outcome was surgical pathology categorized as (i) viable non-teratomatous germ-cell tumor (GCT) (with or without teratoma), (ii) teratoma only, or (iii) fibrosis/necrosis stratified by largest residual mass size. Secondary outcomes included 10-year relapse-free survival, disease-specific survival, and overall survival.

Results

Of 1027 eligible patients, 45% had teratoma and 4% had viable non-teratomatous GCT found at pcRPLND. With a median follow-up of 5.2 years, there was one isolated retroperitoneal relapse and 26 GCT-related deaths. As the residual mass size increased, the likelihood of teratoma in the pcRPLND specimen increased from ∼20% (residual masses <1 cm) to ∼70% (>5 cm). The risk of viable non-teratomatous GCT similarly increased from ∼2% up to ∼10%. Ten-year relapse-free and overall survival worsened with increasing mass size. Adjusting for risk group, clinical stage, residual mass size, and lymphovascular invasion at orchiectomy, the presence of yolk sac tumor [odds ratio (OR) 1.86, 95% confidence interval (CI) 1.35-2.56] and teratoma in the orchiectomy specimen (OR 3.09, 95% CI 2.27-4.23) were each independently associated with finding teratoma or viable non-teratomatous GCT at pcRPLND.

Conclusions

Following first-line chemotherapy, pcRPLND provides effective control of the retroperitoneum with few relapses and GCT-related deaths. Guideline recommendations for or against pcRPLND based on residual mass size alone should be revisited due to the significant association of orchiectomy histology with pcRPLND pathology and the benefits surgical consolidation has on disease control and survival.

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转移性非半细胞性生殖细胞肿瘤一线化疗后腹膜后淋巴结清扫的肿瘤学结果。

背景：化疗后腹膜后淋巴结清扫（pcRPLND）是转移性非半细胞性生殖细胞肿瘤（NSGCT）患者多模式治疗的组成部分。我们回顾了一线化疗后pcRPLND的病理和长期预后，重点关注残留肿块大小和原发肿瘤组织学。我们的目标是确定新的预测方法，以改善手术指征。患者和方法：纳入了2000年1月1日至2023年1月18日期间在我院接受一线化疗后的NSGCT pcRPLND患者。主要结果是手术病理分类为1)可存活的非畸胎瘤性生殖细胞瘤（GCT）（伴或不伴畸胎瘤），2)仅畸胎瘤，或3)按最大残余肿块大小分层的纤维化/坏死。次要结局包括10年无复发生存、疾病特异性生存和总生存。结果：在1027例符合条件的患者中，45%有畸胎瘤，4%在pcRPLND发现存活的非畸胎性GCT。中位随访时间为5.2年，有1例孤立性腹膜后复发和26例gct相关死亡。随着残余肿块大小的增加，pcRPLND标本中畸胎瘤的可能性从20%（残余肿块5 cm）增加。存活的非畸胎性GCT的风险同样从2%增加到10%。10年无复发和总生存率随着肿块大小的增加而恶化。调整风险组、临床分期、残余肿块大小和睾丸切除术时淋巴血管浸润后，卵黄囊肿瘤（比值比[OR] 1.86, 95%可信区间[CI] 1.35-2.56）和睾丸切除术标本中畸胎瘤（比值比[OR] 3.09, 95% CI 2.27-4.23）的存在与pcRPLND中发现畸胎瘤或存活的非畸胎性GCT分别独立相关。结论：在一线化疗后，pcRPLND能有效控制腹膜后肿瘤，复发少，gct相关死亡少。由于睾丸切除术组织学与pcRPLND病理的显著相关性以及手术巩固对疾病控制和生存的益处，应重新考虑仅基于残余肿块大小支持或反对pcRPLND的指南建议。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Annals of Oncology 医学-肿瘤学

CiteScore

63.90

自引率

1.00%

发文量

3712

审稿时长

2-3 weeks

期刊介绍： Annals of Oncology, the official journal of the European Society for Medical Oncology and the Japanese Society of Medical Oncology, offers rapid and efficient peer-reviewed publications on innovative cancer treatments and translational research in oncology and precision medicine. The journal primarily focuses on areas such as systemic anticancer therapy, with a specific emphasis on molecular targeted agents and new immune therapies. We also welcome randomized trials, including negative results, as well as top-level guidelines. Additionally, we encourage submissions in emerging fields that are crucial to personalized medicine, such as molecular pathology, bioinformatics, modern statistics, and biotechnologies. Manuscripts related to radiotherapy, surgery, and pediatrics will be considered if they demonstrate a clear interaction with any of the aforementioned fields or if they present groundbreaking findings. Our international editorial board comprises renowned experts who are leaders in their respective fields. Through Annals of Oncology, we strive to provide the most effective communication on the dynamic and ever-evolving global oncology landscape.