Outcome analysis for patients with elevated serum tumor markers at postchemotherapy retroperitoneal lymph node dissection

Stephen D W Beck, Richard Foster, Richard Bihrle, Lawrence Einhorn, John P. Donohue

Research output: Contribution to journalArticle

69 Citations (Scopus)

Abstract

Purpose: To evaluate the therapeutic benefit of postchemotherapy retroperitoneal lymph node dissection (PCRPLND) in patients with persistently elevated serum tumor markers. Patients and Methods: One hundred fourteen patients with metastatic germ cell cancer with elevated serum tumor markers after first-line (50 patients) or second-line chemotherapy (64 patients) who underwent PCRPLND between 1977 and 2000 with a minimum follow-up of 2-years were included in this retrospective study. Results: The 5-year overall survival was 53.9%. Sixty-one patients (53.5%) are alive with a medium follow-up of 72 months. Fifty-three patients died of disease, with a medium time to death of 8.0 months. Mean preoperative serum alpha-fetoprotein (AFP) and beta-human chorionic gonadotropin (βHCG) levels were 483 ng/mL and 555 mU/mL, respectively, with no difference in 5-year survival (P = .2). Retroperitoneal pathology revealed germ cell cancer in 53.5% of patients, teratoma in 34.2% of patients, and fibrosis in 12.2% of patients, with 5-year survival rates of 31.4%, 77.5%, and 85.7%, respectively (P < .0001). Predictors of retroperitoneal pathology included an increasing serum AFP or βHCG, βHCG more than 100 ng/mL, redo retroperitoneal lymph node dissection (RPLND), and second-line chemotherapy. Poor prognostic variables by multivariable analysis included βHCG status, serum AFP level, redo RPLND, and germ cell cancer in the resected specimen. Conclusion: A subset of patients with elevated serum tumor markers after chemotherapy is curable with surgery. The prognostic factors predictive of outcome in this analysis include an increasing βHCG, serum AFP level, redo RPLND, and germ cell cancer in the resected specimen. These factors, along with clinical and surgical experience, should aid in determining the appropriate integration of surgery and chemotherapy in this population.

Original languageEnglish
Pages (from-to)6149-6156
Number of pages8
JournalJournal of Clinical Oncology
Volume23
Issue number25
DOIs
StatePublished - 2005

Fingerprint

Tumor Biomarkers
Lymph Node Excision
Biomarkers
Chorionic Gonadotropin
Germ Cell and Embryonal Neoplasms
alpha-Fetoproteins
Drug Therapy
Serum
Alpha Subunit Glycoprotein Hormones
Pathology
Survival
Teratoma
Fibrosis
Survival Rate
Retrospective Studies

ASJC Scopus subject areas

  • Cancer Research
  • Oncology

Cite this

@article{5c5fa974258e4b0ab3b0d2414e15454c,
title = "Outcome analysis for patients with elevated serum tumor markers at postchemotherapy retroperitoneal lymph node dissection",
abstract = "Purpose: To evaluate the therapeutic benefit of postchemotherapy retroperitoneal lymph node dissection (PCRPLND) in patients with persistently elevated serum tumor markers. Patients and Methods: One hundred fourteen patients with metastatic germ cell cancer with elevated serum tumor markers after first-line (50 patients) or second-line chemotherapy (64 patients) who underwent PCRPLND between 1977 and 2000 with a minimum follow-up of 2-years were included in this retrospective study. Results: The 5-year overall survival was 53.9{\%}. Sixty-one patients (53.5{\%}) are alive with a medium follow-up of 72 months. Fifty-three patients died of disease, with a medium time to death of 8.0 months. Mean preoperative serum alpha-fetoprotein (AFP) and beta-human chorionic gonadotropin (βHCG) levels were 483 ng/mL and 555 mU/mL, respectively, with no difference in 5-year survival (P = .2). Retroperitoneal pathology revealed germ cell cancer in 53.5{\%} of patients, teratoma in 34.2{\%} of patients, and fibrosis in 12.2{\%} of patients, with 5-year survival rates of 31.4{\%}, 77.5{\%}, and 85.7{\%}, respectively (P < .0001). Predictors of retroperitoneal pathology included an increasing serum AFP or βHCG, βHCG more than 100 ng/mL, redo retroperitoneal lymph node dissection (RPLND), and second-line chemotherapy. Poor prognostic variables by multivariable analysis included βHCG status, serum AFP level, redo RPLND, and germ cell cancer in the resected specimen. Conclusion: A subset of patients with elevated serum tumor markers after chemotherapy is curable with surgery. The prognostic factors predictive of outcome in this analysis include an increasing βHCG, serum AFP level, redo RPLND, and germ cell cancer in the resected specimen. These factors, along with clinical and surgical experience, should aid in determining the appropriate integration of surgery and chemotherapy in this population.",
author = "Beck, {Stephen D W} and Richard Foster and Richard Bihrle and Lawrence Einhorn and Donohue, {John P.}",
year = "2005",
doi = "10.1200/JCO.2005.11.684",
language = "English",
volume = "23",
pages = "6149--6156",
journal = "Journal of Clinical Oncology",
issn = "0732-183X",
publisher = "American Society of Clinical Oncology",
number = "25",

}

TY - JOUR

T1 - Outcome analysis for patients with elevated serum tumor markers at postchemotherapy retroperitoneal lymph node dissection

AU - Beck, Stephen D W

AU - Foster, Richard

AU - Bihrle, Richard

AU - Einhorn, Lawrence

AU - Donohue, John P.

PY - 2005

Y1 - 2005

N2 - Purpose: To evaluate the therapeutic benefit of postchemotherapy retroperitoneal lymph node dissection (PCRPLND) in patients with persistently elevated serum tumor markers. Patients and Methods: One hundred fourteen patients with metastatic germ cell cancer with elevated serum tumor markers after first-line (50 patients) or second-line chemotherapy (64 patients) who underwent PCRPLND between 1977 and 2000 with a minimum follow-up of 2-years were included in this retrospective study. Results: The 5-year overall survival was 53.9%. Sixty-one patients (53.5%) are alive with a medium follow-up of 72 months. Fifty-three patients died of disease, with a medium time to death of 8.0 months. Mean preoperative serum alpha-fetoprotein (AFP) and beta-human chorionic gonadotropin (βHCG) levels were 483 ng/mL and 555 mU/mL, respectively, with no difference in 5-year survival (P = .2). Retroperitoneal pathology revealed germ cell cancer in 53.5% of patients, teratoma in 34.2% of patients, and fibrosis in 12.2% of patients, with 5-year survival rates of 31.4%, 77.5%, and 85.7%, respectively (P < .0001). Predictors of retroperitoneal pathology included an increasing serum AFP or βHCG, βHCG more than 100 ng/mL, redo retroperitoneal lymph node dissection (RPLND), and second-line chemotherapy. Poor prognostic variables by multivariable analysis included βHCG status, serum AFP level, redo RPLND, and germ cell cancer in the resected specimen. Conclusion: A subset of patients with elevated serum tumor markers after chemotherapy is curable with surgery. The prognostic factors predictive of outcome in this analysis include an increasing βHCG, serum AFP level, redo RPLND, and germ cell cancer in the resected specimen. These factors, along with clinical and surgical experience, should aid in determining the appropriate integration of surgery and chemotherapy in this population.

AB - Purpose: To evaluate the therapeutic benefit of postchemotherapy retroperitoneal lymph node dissection (PCRPLND) in patients with persistently elevated serum tumor markers. Patients and Methods: One hundred fourteen patients with metastatic germ cell cancer with elevated serum tumor markers after first-line (50 patients) or second-line chemotherapy (64 patients) who underwent PCRPLND between 1977 and 2000 with a minimum follow-up of 2-years were included in this retrospective study. Results: The 5-year overall survival was 53.9%. Sixty-one patients (53.5%) are alive with a medium follow-up of 72 months. Fifty-three patients died of disease, with a medium time to death of 8.0 months. Mean preoperative serum alpha-fetoprotein (AFP) and beta-human chorionic gonadotropin (βHCG) levels were 483 ng/mL and 555 mU/mL, respectively, with no difference in 5-year survival (P = .2). Retroperitoneal pathology revealed germ cell cancer in 53.5% of patients, teratoma in 34.2% of patients, and fibrosis in 12.2% of patients, with 5-year survival rates of 31.4%, 77.5%, and 85.7%, respectively (P < .0001). Predictors of retroperitoneal pathology included an increasing serum AFP or βHCG, βHCG more than 100 ng/mL, redo retroperitoneal lymph node dissection (RPLND), and second-line chemotherapy. Poor prognostic variables by multivariable analysis included βHCG status, serum AFP level, redo RPLND, and germ cell cancer in the resected specimen. Conclusion: A subset of patients with elevated serum tumor markers after chemotherapy is curable with surgery. The prognostic factors predictive of outcome in this analysis include an increasing βHCG, serum AFP level, redo RPLND, and germ cell cancer in the resected specimen. These factors, along with clinical and surgical experience, should aid in determining the appropriate integration of surgery and chemotherapy in this population.

UR - http://www.scopus.com/inward/record.url?scp=24944559731&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=24944559731&partnerID=8YFLogxK

U2 - 10.1200/JCO.2005.11.684

DO - 10.1200/JCO.2005.11.684

M3 - Article

C2 - 16135481

AN - SCOPUS:24944559731

VL - 23

SP - 6149

EP - 6156

JO - Journal of Clinical Oncology

JF - Journal of Clinical Oncology

SN - 0732-183X

IS - 25

ER -