Outcomes in patients with clinical Stage III NSGCT who achieve complete clinical response to chemotherapy at extraretroperitoneal disease site

Timothy A. Masterson, Brett S. Carver, Bobby Shayegan, Darren R. Feldman, Robert J. Motzer, George J. Bosl, Joel Sheinfeld

Research output: Contribution to journalArticle

5 Citations (Scopus)

Abstract

Objective: To compare the survival outcomes of patients with advanced nonseminoma and extraretroperitoneal (ERP) disease observed for a clinical complete response (CCR) with those demonstrating a pathologic complete response (PCR). Methods: From 1989 to 2003, 237 patients with clinical Stage III nonseminoma underwent induction chemotherapy followed by retroperitoneal lymph node dissection. After chemotherapy, 107 demonstrated a CCR to treatment at the ERP disease site. Of the remaining 130 patients with radiographic evidence of residual ERP disease, 86 (66%) had fibrosis only on pathologic review (ie, PCR). The probability of progression-free and disease-specific survival was estimated using the Kaplan-Meier method. Cox proportional hazards regression analysis was used to determine the prognostic significance of risk factors for progression and survival. Results: The median follow-up was similar for both CCR and PCR patients (44.5 and 50.7 months, respectively). Overall, the 5-year probability of freedom from progression (93% vs 72%, respectively; P =.0005) and disease-specific survival (96% vs 87%, respectively; P =.08) rates were far better for men with a PCR. The predictors of disease progression included residual retroperitoneal nodal size after chemotherapy (P =.05), and resection of the residual disease at the ERP site was protective (P =.02). Conclusion: A CCR at the ERP disease site is associated with a greater likelihood of relapse compared with a PCR, underscoring the limitations of radiographic imaging after chemotherapy in detecting microscopic residual disease and need for rigorous monitoring of patients observed after a CCR. Furthermore, until more accurate clinical predictors of ERP histologic features are identified, we advocate for complete surgical resection of all sites of residual disease, when feasible.

Original languageEnglish (US)
Pages (from-to)1079-1084
Number of pages6
JournalUrology
Volume79
Issue number5
DOIs
StatePublished - May 1 2012

Fingerprint

Drug Therapy
Survival
Induction Chemotherapy
Physiologic Monitoring
Lymph Node Excision
Disease-Free Survival
Disease Progression
Fibrosis
Regression Analysis
Recurrence
Therapeutics

ASJC Scopus subject areas

  • Urology

Cite this

Outcomes in patients with clinical Stage III NSGCT who achieve complete clinical response to chemotherapy at extraretroperitoneal disease site. / Masterson, Timothy A.; Carver, Brett S.; Shayegan, Bobby; Feldman, Darren R.; Motzer, Robert J.; Bosl, George J.; Sheinfeld, Joel.

In: Urology, Vol. 79, No. 5, 01.05.2012, p. 1079-1084.

Research output: Contribution to journalArticle

Masterson, Timothy A. ; Carver, Brett S. ; Shayegan, Bobby ; Feldman, Darren R. ; Motzer, Robert J. ; Bosl, George J. ; Sheinfeld, Joel. / Outcomes in patients with clinical Stage III NSGCT who achieve complete clinical response to chemotherapy at extraretroperitoneal disease site. In: Urology. 2012 ; Vol. 79, No. 5. pp. 1079-1084.
@article{7eaab5e265224f078f09ba154d670895,
title = "Outcomes in patients with clinical Stage III NSGCT who achieve complete clinical response to chemotherapy at extraretroperitoneal disease site",
abstract = "Objective: To compare the survival outcomes of patients with advanced nonseminoma and extraretroperitoneal (ERP) disease observed for a clinical complete response (CCR) with those demonstrating a pathologic complete response (PCR). Methods: From 1989 to 2003, 237 patients with clinical Stage III nonseminoma underwent induction chemotherapy followed by retroperitoneal lymph node dissection. After chemotherapy, 107 demonstrated a CCR to treatment at the ERP disease site. Of the remaining 130 patients with radiographic evidence of residual ERP disease, 86 (66{\%}) had fibrosis only on pathologic review (ie, PCR). The probability of progression-free and disease-specific survival was estimated using the Kaplan-Meier method. Cox proportional hazards regression analysis was used to determine the prognostic significance of risk factors for progression and survival. Results: The median follow-up was similar for both CCR and PCR patients (44.5 and 50.7 months, respectively). Overall, the 5-year probability of freedom from progression (93{\%} vs 72{\%}, respectively; P =.0005) and disease-specific survival (96{\%} vs 87{\%}, respectively; P =.08) rates were far better for men with a PCR. The predictors of disease progression included residual retroperitoneal nodal size after chemotherapy (P =.05), and resection of the residual disease at the ERP site was protective (P =.02). Conclusion: A CCR at the ERP disease site is associated with a greater likelihood of relapse compared with a PCR, underscoring the limitations of radiographic imaging after chemotherapy in detecting microscopic residual disease and need for rigorous monitoring of patients observed after a CCR. Furthermore, until more accurate clinical predictors of ERP histologic features are identified, we advocate for complete surgical resection of all sites of residual disease, when feasible.",
author = "Masterson, {Timothy A.} and Carver, {Brett S.} and Bobby Shayegan and Feldman, {Darren R.} and Motzer, {Robert J.} and Bosl, {George J.} and Joel Sheinfeld",
year = "2012",
month = "5",
day = "1",
doi = "10.1016/j.urology.2011.11.090",
language = "English (US)",
volume = "79",
pages = "1079--1084",
journal = "Urology",
issn = "0090-4295",
publisher = "Elsevier Inc.",
number = "5",

}

TY - JOUR

T1 - Outcomes in patients with clinical Stage III NSGCT who achieve complete clinical response to chemotherapy at extraretroperitoneal disease site

AU - Masterson, Timothy A.

AU - Carver, Brett S.

AU - Shayegan, Bobby

AU - Feldman, Darren R.

AU - Motzer, Robert J.

AU - Bosl, George J.

AU - Sheinfeld, Joel

PY - 2012/5/1

Y1 - 2012/5/1

N2 - Objective: To compare the survival outcomes of patients with advanced nonseminoma and extraretroperitoneal (ERP) disease observed for a clinical complete response (CCR) with those demonstrating a pathologic complete response (PCR). Methods: From 1989 to 2003, 237 patients with clinical Stage III nonseminoma underwent induction chemotherapy followed by retroperitoneal lymph node dissection. After chemotherapy, 107 demonstrated a CCR to treatment at the ERP disease site. Of the remaining 130 patients with radiographic evidence of residual ERP disease, 86 (66%) had fibrosis only on pathologic review (ie, PCR). The probability of progression-free and disease-specific survival was estimated using the Kaplan-Meier method. Cox proportional hazards regression analysis was used to determine the prognostic significance of risk factors for progression and survival. Results: The median follow-up was similar for both CCR and PCR patients (44.5 and 50.7 months, respectively). Overall, the 5-year probability of freedom from progression (93% vs 72%, respectively; P =.0005) and disease-specific survival (96% vs 87%, respectively; P =.08) rates were far better for men with a PCR. The predictors of disease progression included residual retroperitoneal nodal size after chemotherapy (P =.05), and resection of the residual disease at the ERP site was protective (P =.02). Conclusion: A CCR at the ERP disease site is associated with a greater likelihood of relapse compared with a PCR, underscoring the limitations of radiographic imaging after chemotherapy in detecting microscopic residual disease and need for rigorous monitoring of patients observed after a CCR. Furthermore, until more accurate clinical predictors of ERP histologic features are identified, we advocate for complete surgical resection of all sites of residual disease, when feasible.

AB - Objective: To compare the survival outcomes of patients with advanced nonseminoma and extraretroperitoneal (ERP) disease observed for a clinical complete response (CCR) with those demonstrating a pathologic complete response (PCR). Methods: From 1989 to 2003, 237 patients with clinical Stage III nonseminoma underwent induction chemotherapy followed by retroperitoneal lymph node dissection. After chemotherapy, 107 demonstrated a CCR to treatment at the ERP disease site. Of the remaining 130 patients with radiographic evidence of residual ERP disease, 86 (66%) had fibrosis only on pathologic review (ie, PCR). The probability of progression-free and disease-specific survival was estimated using the Kaplan-Meier method. Cox proportional hazards regression analysis was used to determine the prognostic significance of risk factors for progression and survival. Results: The median follow-up was similar for both CCR and PCR patients (44.5 and 50.7 months, respectively). Overall, the 5-year probability of freedom from progression (93% vs 72%, respectively; P =.0005) and disease-specific survival (96% vs 87%, respectively; P =.08) rates were far better for men with a PCR. The predictors of disease progression included residual retroperitoneal nodal size after chemotherapy (P =.05), and resection of the residual disease at the ERP site was protective (P =.02). Conclusion: A CCR at the ERP disease site is associated with a greater likelihood of relapse compared with a PCR, underscoring the limitations of radiographic imaging after chemotherapy in detecting microscopic residual disease and need for rigorous monitoring of patients observed after a CCR. Furthermore, until more accurate clinical predictors of ERP histologic features are identified, we advocate for complete surgical resection of all sites of residual disease, when feasible.

UR - http://www.scopus.com/inward/record.url?scp=84860485513&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=84860485513&partnerID=8YFLogxK

U2 - 10.1016/j.urology.2011.11.090

DO - 10.1016/j.urology.2011.11.090

M3 - Article

C2 - 22446341

AN - SCOPUS:84860485513

VL - 79

SP - 1079

EP - 1084

JO - Urology

JF - Urology

SN - 0090-4295

IS - 5

ER -