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Comparative Study
. 2010 Jun;75(6):1431-5.
doi: 10.1016/j.urology.2009.11.076. Epub 2010 Mar 17.

The total number of retroperitoneal lymph nodes resected impacts clinical outcome after chemotherapy for metastatic testicular cancer

Brett S Carver  1 , Angel M Cronin, Scott Eggener, Caroline J Savage, Robert J Motzer, Dean Bajorin, George J Bosl, Joel Sheinfeld
Affiliations
Comparative Study

The total number of retroperitoneal lymph nodes resected impacts clinical outcome after chemotherapy for metastatic testicular cancer

Brett S Carver et al. Urology. 2010 Jun.

Abstract

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.

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Figures

Figure 1
Figure 1
Total number of lymph nodes removed according to retroperitoneal nodal size
Figure 2
Figure 2
Predicted 2-year relapse-free probability by number of nodes removed, adjusting for nodal size. Dashed line: number of nodes modeled with cubic splines; Solid line: number of nodes modeled with a quadratic term. Unadjusted Kaplan-Meier estimates of the 2-year relapse-free probability for patients with x nodes removed are given as a scatter-plot.
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