The Total Number of Retroperitoneal Lymph Nodes Resected Impacts Clinical Outcome After Chemotherapy for Metastatic Testicular Cancer

被引:42
作者
Carver, Brett S.
Cronin, Angel M.
Eggener, Scott
Savage, Caroline J.
Motzer, Robert J.
Bajorin, Dean
Bosl, George J.
Sheinfeld, Joel
机构
[1] Mem Sloan Kettering Canc Ctr, Dept Surg & Urol Serv, New York, NY 10021 USA
[2] Mem Sloan Kettering Canc Ctr, Dept Epidemiol & Biostat, New York, NY 10021 USA
[3] Mem Sloan Kettering Canc Ctr, Dept Med, New York, NY 10021 USA
[4] Mem Sloan Kettering Canc Ctr, Dept Genitourinary Oncol Serv, New York, NY 10021 USA
关键词
GERM-CELL TUMORS; RADICAL CYSTECTOMY; PROSTATE-CANCER; PELVIC LYMPHADENECTOMY; NODAL METASTASIS; DISSECTION; EJACULATION; ALWAYS; COUNT;
D O I
10.1016/j.urology.2009.11.076
中图分类号
R5 [内科学]; R69 [泌尿科学(泌尿生殖系疾病)];
学科分类号
1002 ; 100201 ;
摘要
OBJECTIVES To evaluate the prognostic significance of the total number of lymph nodes obtained at postchemotherapy retroperitoneal lymph node dissection (PC-RPLND). After the multidisciplinary management of metastatic germ cell tumor, approximately 10%-15% of patients with the histologic finding of fibrosis or teratoma will suffer disease recurrence. METHODS Between 1989 and 2006, a total of 628 patients underwent PC-RPLND and were found to have either fibrosis or teratoma. After Institutional Review Board approval, complete clinical and pathologic data were obtained from our prospective testis cancer surgical database. A Cox proportional hazards regression model was constructed to evaluate the association of the total number of lymph nodes obtained at PC-RPLND on disease recurrence. RESULTS On pathologic evaluation, 248 (57%) patients had fibrosis and 184 (43%) patients had teratoma. The median number of lymph nodes resected was 25 (interquartile range, 15-37). On multivariable analysis, increasing postchemotherapy nodal size and decreasing lymph node counts were significant predictors of disease recurrence (P = .01, .04, respectively). For patients with 10 nodes removed, the predicted 2-year relapse free probability was 90%, compared with 97% when 50 nodes were removed. CONCLUSIONS Our data suggest that the total number of lymph nodes removed and analyzed is an independent predictor of disease recurrence after PC-RPLND. This has implications both for the urologist to assure completeness of resection and for the pathologist to meticulously assess the pathologic specimens. UROLOGY 75: 1431-1435, 2010. (c) 2010 Elsevier Inc.
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页码:1431 / 1435
页数:5
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