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Retroperitoneal lymph node dissection for testicular seminomas: population-based practice and survival outcomes
Hiten D Patel1, Gregory A Joice2, Zeyad R Schwen2
1The James Buchanan Brady Urological Institute and Department of Urology, Johns Hopkins University School of Medicine, 600 N. Wolfe Street/Marburg 134, Baltimore, MD, 21287, USA. hitenpatel@jhmi.edu.
World Journal of Urology
|October 14, 2017
Summary
Retroperitoneal lymph node dissection (RPLND) use for testicular seminoma remains stable, primarily for stage II disease. Patients undergoing RPLND, often higher risk, show comparable survival to those not receiving it.
Area of Science:
- Urology
- Surgical Oncology
- Medical Oncology
Background:
- Retroperitoneal lymph node dissection (RPLND) is traditionally for nonseminomatous germ cell tumors.
- Interest in RPLND for testicular seminomas is growing to mitigate chemotherapy/radiation toxicities.
- Current RPLND use for testicular seminoma is primarily in the post-chemotherapy setting for stage II disease.
Purpose of the Study:
- To evaluate the current utilization of RPLND for testicular seminomas across different stages.
- To assess the survival implications of RPLND in patients with testicular seminoma.
- To identify predictors of RPLND use in this patient population.
Main Methods:
- Analysis of a national sample of men diagnosed with testicular seminoma (stages IA-IIC) from 1988-2013 using SEER registries.
- Determination of stage-specific RPLND utilization rates.
- Cox proportional hazards models to evaluate overall survival (OS) and cancer-specific survival (CSS), adjusted for relevant covariates.
Main Results:
- RPLND utilization was low for stage I (1.3%) and higher for stage II (10.6%) testicular seminoma, with no significant time trends.
- Patients receiving RPLND did not demonstrate worse OS or CSS on stage-by-stage analysis.
- Higher stage disease (IIA-IIC) predicted greater need for RPLND, while radiotherapy decreased its use (OR 0.40).
Conclusions:
- RPLND utilization for testicular seminoma in the post-chemotherapy setting has been consistent over 25 years.
- Patients selected for RPLND represent a higher-risk group, yet survival outcomes appear comparable.
- Future trials exploring RPLND as a primary treatment or for isolated relapse are needed to further define its role.