Carver Brett S, Shayegan Bobby, Eggener Scott, Stasi Jason, Motzer Robert J, Bosl George J, Sheinfeld Joel
Department of Urology and Medical Oncology, Memorial Sloan-Kettering Cancer Center, New York, NY, USA.
J Clin Oncol. 2007 Oct 1;25(28):4365-9. doi: 10.1200/JCO.2007.11.2078.
Modified template retroperitoneal lymph node dissections (RPLND) have become increasing applied in the postchemotherapy (PC) setting. We evaluated our experience with PC-RPLND to determine the incidence of disease extending outside the boundaries of a modified PC-RPLND.
From 1989 through 2003, a total of 532 men underwent PC-RPLND for metastatic nonseminomatous germ cell tumor (NSGCT). Of these, 269 (51%) had either viable germ cell tumor (GCT) or teratoma present in the RPLND specimen. After Institutional Review Board approval, clinical and pathologic data were obtained from our prospective surgical database. The incidence of retroperitoneal disease outside the boundaries of five modified templates was reported for the presence of viable GCT or teratoma.
Of the 269 patients with viable GCT or teratoma, 20 to 86 (7% to 32%) patients had evidence of extratemplate retroperitoneal disease, depending on the boundaries of the modified template. There was no difference in the histologic distribution for patients with disease confined to or outside of the modified templates. Despite the absence of preoperative radiographic evidence of disease outside the boundaries of the Testicular Tumor Study Group template, the incidence of extratemplate metastasis for men with residual retroperitoneal masses less than 1, 1 to 2, 2 to 5, and more than 5 cm was two of 24 (8%), seven of 38 (18%), 27 of 92 (29%), and 14 of 55 (25%), respectively.
Our data suggest a bilateral RPLND is a prudent approach for the management of men with metastatic NSGCT after chemotherapy, given that at least 7% to 32% of men will have teratoma or viable GCT outside the boundaries of a modified template.
改良模板腹膜后淋巴结清扫术（RPLND）在化疗后（PC）的情况下应用越来越广泛。我们评估了我们在PC-RPLND方面的经验，以确定疾病超出改良PC-RPLND边界的发生率。
从1989年到2003年，共有532名男性因转移性非精原细胞性生殖细胞肿瘤（NSGCT）接受了PC-RPLND。其中，269例（51%）的RPLND标本中存在活的生殖细胞肿瘤（GCT）或畸胎瘤。经机构审查委员会批准后，从我们的前瞻性手术数据库中获取临床和病理数据。报告了在存在活的GCT或畸胎瘤的情况下，超出五个改良模板边界的腹膜后疾病的发生率。
在269例有活的GCT或畸胎瘤的患者中，根据改良模板的边界，有20至86例（7%至32%）患者有模板外腹膜后疾病的证据。局限于改良模板内或超出改良模板外的患者，其组织学分布没有差异。尽管术前影像学检查没有证据表明疾病超出睾丸肿瘤研究组模板的边界，但残留腹膜后肿块小于1cm、1至2cm、2至5cm和大于5cm的男性患者，其模板外转移的发生率分别为24例中的2例（8%）、38例中的7例（18%）、92例中的27例（29%）和55例中的14例（25%）。
我们的数据表明，对于化疗后转移性NSGCT的男性患者，双侧RPLND是一种谨慎的治疗方法，因为至少7%至32%的男性患者会在改良模板边界外出现畸胎瘤或活的GCT。
