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. 2021 Jul;28(7):3648-3655.
doi: 10.1245/s10434-021-09696-3. Epub 2021 Mar 10.

Retroperitoneal Lymph Node Dissection Versus Surveillance for Adult Early Stage Pure Testicular Teratoma: A Nationwide Analysis

Ali Hajiran  1 , Mounsif Azizi  2 , Ahmet M Aydin  2 , Nicholas H Chakiryan  2 , Charles C Peyton  2 , David C Boulware  3 , Brandon J Manley  2   4 , Scott M Gilbert  2 , Wade J Sexton  2
Affiliations

Retroperitoneal Lymph Node Dissection Versus Surveillance for Adult Early Stage Pure Testicular Teratoma: A Nationwide Analysis

Ali Hajiran et al. Ann Surg Oncol. 2021 Jul.

Abstract

Purpose: Following radical orchiectomy, surveillance and primary retroperitoneal lymph node dissection (RPLND) are acceptable options for the management of early stage pure testicular teratoma in adult patients; however, there is no uniform consensus. The aim of this study was to investigate survival outcomes of adults with early stage pure testicular teratoma based on management strategy.

Methods: Data was extracted from the National Cancer Database (NCDB) from testicular cancer patients diagnosed with clinical stage (CS) I pure teratoma (pT1-4N0M0S0) between 2004 and 2014. Kaplan-Meier and Cox regression analyses were used to assess clinical outcomes based on management strategy.

Results: Of the 61,167 patients diagnosed with testicular cancer, 692 (1.1%) had pure teratoma. Only individuals with CS I disease were considered (n = 237). The median age was 28 (23-35) years. Overall, 43 (18%) patients underwent RPLND and 194 (82%) patients were managed with surveillance. There was an increase in surveillance for CS I teratoma during the study period. Increasing distance from residence to treatment facility was an unadjusted predictor for undergoing primary RPLND (p < 0.001). Median follow-up was 54 months and there was no significant difference in overall survival between CS I teratoma patients managed with RPLND and those managed with surveillance (p = 0.13).

Conclusions: There has been a trend toward increasing adoption of surveillance for the management of early stage pure testicular teratoma in adults. Our findings suggest that surveillance provides comparable survival outcomes to primary retroperitoneal lymph node dissection in this setting.

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Conflict of interest statement

DISCLOSURE All authors have no conflicts of interest to report regarding the data presented in this current study. All authors have read and approved this manuscript and it is not under consideration for publication elsewhere, nor has it previously been published. All authors have contributed to the information and material presented. No authors have direct or indirect commercial or financial incentives associated with the publication of this manuscript. No extra-institutional funding was required. The study was reviewed and approved by our institutional review board for ethics. We certify that the material in this assignment is our own work and not plagiarized.

Figures

FIG. 1.
FIG. 1.
CONSORT diagram for patients with clinical stage I pure testicular teratoma from the National Cancer Database (2004–2014) managed with surveillance versus retroperitoneal lymph node dissection
FIG. 2.
FIG. 2.
Trends for surveillance compared with retroperitoneal lymph node dissections for patients with clinical stage I pure testicular teratoma form the National Cancer Database
FIG. 3.
FIG. 3.
Unadjusted Kaplan-Meier analysis of overall survival in patients with clinical stage I testicular pure teratoma managed with surveillance versus retroperitoneal lymph node dissection
See this image and copyright information in PMC

Comment in

References

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