Carver Brett S, Bianco Fernando J, Shayegan Bobby, Vickers Andrew, Motzer Robert J, Bosl George J, Sheinfeld Joel
Department of Urology, Memorial Sloan-Kettering Cancer Center, New York, NY, USA.
J Urol. 2006 Jul;176(1):100-3; discussion 103-4. doi: 10.1016/S0022-5347(06)00508-8.
The biological potential of teratoma remains unpredictable, therefore identifying its presence in the retroperitoneum remains important. We evaluated patients undergoing post-chemotherapy retroperitoneal lymph node dissection for nonseminomatous germ cell tumors to determine predictors of teratomatous elements in the retroperitoneum.
We identified 532 patients from 1989 to 2003 who underwent retroperitoneal lymph node dissection following chemotherapy for nonseminomatous germ cell tumors at our institution. Multiple clinical and pathological variables were reviewed from our prospective retroperitoneal lymph node dissection database. A logistic regression model was designed based on preoperative variables to predict the presence of teratomatous elements in the retroperitoneal lymph node dissection specimen.
Of the 532 patients in our series 450 (85%) received only induction chemotherapy and 82 (15%) required salvage chemotherapy. Teratomatous elements were identified in the orchiectomy specimen in 42% of patients. Retroperitoneal nodal pathology revealed teratomatous elements in 235 (44%) patients and only teratoma in 210 (40%) patients. By multivariate analysis testicular yolk sac tumor (p = 0.046), teratoma in the orchiectomy specimen (p <0.005), relative change in nodal size before and after chemotherapy (p <0.005), and no requirement for salvage chemotherapy (p = 0.03) were independent predictors for the presence of teratoma in the retroperitoneum.
Teratoma remains a common histological finding in the retroperitoneal lymph nodes following chemotherapy. We have identified several pre-retroperitoneal lymph node dissection variables that predict the finding of teratoma in the retroperitoneum for men treated with chemotherapy for metastatic nonseminomatous germ cell tumors.
畸胎瘤的生物学潜能仍不可预测，因此确定其在腹膜后的存在仍然很重要。我们评估了接受非精原性生殖细胞肿瘤化疗后腹膜后淋巴结清扫术的患者，以确定腹膜后畸胎瘤成分的预测因素。
我们从1989年至2003年期间在本机构接受非精原性生殖细胞肿瘤化疗后腹膜后淋巴结清扫术的患者中识别出532例。从我们前瞻性的腹膜后淋巴结清扫术数据库中回顾了多个临床和病理变量。基于术前变量设计了一个逻辑回归模型，以预测腹膜后淋巴结清扫标本中畸胎瘤成分的存在。
在我们系列研究的532例患者中，450例（85%）仅接受诱导化疗，82例（15%）需要挽救性化疗。42%的患者在睾丸切除标本中发现了畸胎瘤成分。腹膜后淋巴结病理显示，235例（44%）患者存在畸胎瘤成分，210例（40%）患者仅为畸胎瘤。多因素分析显示，睾丸卵黄囊瘤（p = 0.046）、睾丸切除标本中的畸胎瘤（p <0.005）、化疗前后淋巴结大小的相对变化（p <0.005）以及不需要挽救性化疗（p = 0.03）是腹膜后存在畸胎瘤的独立预测因素。
畸胎瘤仍然是化疗后腹膜后淋巴结常见的组织学表现。我们已经确定了几个腹膜后淋巴结清扫术前变量，这些变量可以预测接受转移性非精原性生殖细胞肿瘤化疗男性患者腹膜后畸胎瘤的发现情况。
