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Primary Retroperitoneal Lymph Node Dissection in Marker-Positive Clinical Stage II Nonseminomatous Germ Cell Tumors
Ahmad Mousa1,2, Julian Chavarriaga1,2, Sanchit Kaushal2
1Division of Urology, Department of Surgery, University of Toronto, Toronto, Ontario, Canada.
Primary retroperitoneal lymph node dissection (pRPLND) offers long-term disease control for clinical stage II non-seminomatous germ cell tumors (NSGCT) even with elevated serum tumor markers (STMs). While marker-positive patients have higher relapse risk, successful salvage treatment is often possible.
Area of Science:
- Urology
- Oncology
- Surgical Oncology
Background:
- Clinical stage II non-seminomatous germ cell tumors (NSGCT) with elevated serum tumor markers (STMs) typically receive chemotherapy.
- Primary retroperitoneal lymph node dissection (pRPLND) is an alternative treatment approach.
Purpose of the Study:
- To evaluate the oncologic and perioperative outcomes of pRPLND in patients with marker-positive versus marker-negative clinical stage II NSGCT.
Main Methods:
- Retrospective review of patients undergoing pRPLND from 1983-2022.
- Primary endpoint: relapse-free survival (RFS). Secondary endpoints: cancer-specific survival (CSS), relapse location, perioperative outcomes.
- Statistical analysis included Kaplan-Meier, log-rank testing, and multivariable COX regression.
Main Results:
- Elevated STMs (65/207 patients) were associated with higher relapse risk (5-year RFS 75% vs. 93%, p<0.001) and lower CSS (96% vs. 100%, p=0.009).
- Elevated AFP correlated with worse CSS; dual marker elevation predicted greater relapse risk.
- Surgical complication rates were similar between marker-positive and marker-negative groups.
Conclusions:
- Despite increased relapse and mortality risk, pRPLND achieves long-term disease control in approximately 75% of marker-positive CSII NSGCT patients.
- Most relapses are treatable with salvage chemotherapy in compliant patients.
- Multidisciplinary decisions should balance pRPLND's risks against chemotherapy's long-term morbidity.
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