Reoperative retroperitoneal lymph node dissection for metastatic germ cell tumors

Analysis of local recurrence and predictors of survival

Jose A. Pedrosa, Timothy Masterson, Kevin R. Rice, Richard Bihrle, Stephen D W Beck, Richard Foster

Research output: Contribution to journalArticle

6 Citations (Scopus)

Abstract

Purpose While reoperative retroperitoneal lymph node dissection results in durable long-term survival, outcomes are comparatively worse than in patients who undergo initial adequate resection. We identified predictors of cancer specific survival and correlated technical aspects of initial resection to local recurrence in patients treated with repeat retroperitoneal lymph node dissection. Materials and Methods We reviewed subsequent data on 203 patients treated with reoperation for recurrent retroperitoneal germ cell tumor after initial retroperitoneal lymph node dissection with local relapse. We used multivariate Cox proportion hazard models for cancer specific survival and multivariate logistic regression for local recurrence. Results The only 2 factors associated with local recurrence at lymph node dissection were incomplete lumbar vessel division at initial resection (p <0.01) and teratoma histology in the reoperative pathology specimen (p = 0.01). Median followup was 73 months. Initial survival analysis including preoperative variables indicated that active cancer at initial operation (p = 0.04), increased serum tumor markers (p = 0.02), M1b stage (p <0.01) and salvage chemotherapy (p = 0.01) were independent predictors of worse cancer specific survival. After introducing the final pathological data from reoperation into the final multivariate model only active cancer at reoperation (p <0.01), M1b stage (p = 0.01) and salvage chemotherapy before reoperation (p = 0.02) retained the association with worse oncologic outcomes. Conclusions Tumor biology and inadequate surgical technique (incomplete lumbar ligation) are associated with local recurrence after initial retroperitoneal lymph node dissection. Decreased cancer specific survival is expected in this population, mostly driven by active cancer in the final pathology specimen.

Original languageEnglish
Pages (from-to)1777-1782
Number of pages6
JournalJournal of Urology
Volume191
Issue number6
DOIs
StatePublished - 2014

Fingerprint

Germ Cell and Embryonal Neoplasms
Lymph Node Excision
Recurrence
Survival
Reoperation
Neoplasms
Pathology
Drug Therapy
Teratoma
Survival Analysis
Tumor Biomarkers
Proportional Hazards Models
Ligation
Histology
Biomarkers
Logistic Models
Population

Keywords

  • germ cell and embryonal
  • lymph node excision
  • neoplasm recurrence
  • neoplasms
  • reoperation
  • testis

ASJC Scopus subject areas

  • Urology
  • Medicine(all)

Cite this

Reoperative retroperitoneal lymph node dissection for metastatic germ cell tumors : Analysis of local recurrence and predictors of survival. / Pedrosa, Jose A.; Masterson, Timothy; Rice, Kevin R.; Bihrle, Richard; Beck, Stephen D W; Foster, Richard.

In: Journal of Urology, Vol. 191, No. 6, 2014, p. 1777-1782.

Research output: Contribution to journalArticle

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N2 - Purpose While reoperative retroperitoneal lymph node dissection results in durable long-term survival, outcomes are comparatively worse than in patients who undergo initial adequate resection. We identified predictors of cancer specific survival and correlated technical aspects of initial resection to local recurrence in patients treated with repeat retroperitoneal lymph node dissection. Materials and Methods We reviewed subsequent data on 203 patients treated with reoperation for recurrent retroperitoneal germ cell tumor after initial retroperitoneal lymph node dissection with local relapse. We used multivariate Cox proportion hazard models for cancer specific survival and multivariate logistic regression for local recurrence. Results The only 2 factors associated with local recurrence at lymph node dissection were incomplete lumbar vessel division at initial resection (p <0.01) and teratoma histology in the reoperative pathology specimen (p = 0.01). Median followup was 73 months. Initial survival analysis including preoperative variables indicated that active cancer at initial operation (p = 0.04), increased serum tumor markers (p = 0.02), M1b stage (p <0.01) and salvage chemotherapy (p = 0.01) were independent predictors of worse cancer specific survival. After introducing the final pathological data from reoperation into the final multivariate model only active cancer at reoperation (p <0.01), M1b stage (p = 0.01) and salvage chemotherapy before reoperation (p = 0.02) retained the association with worse oncologic outcomes. Conclusions Tumor biology and inadequate surgical technique (incomplete lumbar ligation) are associated with local recurrence after initial retroperitoneal lymph node dissection. Decreased cancer specific survival is expected in this population, mostly driven by active cancer in the final pathology specimen.

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