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Predicting necrosis in residual mass analysis after retroperitoneal lymph node dissection: a retrospective study
Eduardo de Paula Miranda1, Daniel Kanda Abe, Adriano João Nesrallah
1Division of Urology, University of Sao Paulo Medical School and Cancer Institute of Sao Paulo, ICESP, São Paulo, SP, Brazil.
World Journal of Surgical Oncology
|October 2, 2012
Summary
Predicting necrosis in testicular cancer residual masses is crucial. A 35% reduction in retroperitoneal mass size, absence of teratoma, and presence of choriocarcinoma predict necrosis, potentially guiding treatment decisions for germ cell tumors.
Area of Science:
- Oncology
- Urology
- Pathology
Background:
- Up to 50% of patients with testicular germ cell tumors (GCT) show necrosis or fibrosis in retroperitoneal residual masses post-chemotherapy.
- Predicting the nature of these masses is essential for appropriate patient management.
Purpose of the Study:
- To identify clinical and pathological variables that predict necrosis in retroperitoneal residual masses after chemotherapy in testicular GCT patients.
- To evaluate the efficacy of post-chemotherapy retroperitoneal lymph node dissection (PC-RPLND) in predicting tumor presence.
Main Methods:
- Retrospective analysis of 32 patients who underwent PC-RPLND between 2005 and 2011.
- Data collected included mass size, orchiectomy histology, tumor markers, and nodal size before and after chemotherapy.
Main Results:
- 15 patients (47%) had necrosis, 15 (47%) had teratoma, and 2 (6.4%) had viable GCT.
- Significant predictors of necrosis included relative decrease in retroperitoneal lymph node size (P=0.04), absence of teratoma (P=0.03), and presence of choriocarcinoma (P=0.03).
- A 35% reduction in mass size predicted absence of tumor with 73.3% sensitivity and 82.4% specificity.
Conclusions:
- PC-RPLND is the gold standard for residual masses.
- Patients without teratoma and with ≥35% mass shrinkage have a lower chance of viable GCT or teratoma.
- Consideration of surveillance programs for select patients may be appropriate.