Cho Jane S, Kaimakliotis Hristos Z, Cary Clint, Masterson Timothy A, Beck Stephen, Foster Richard
Department of Urology, Indiana University School of Medicine, Indianapolis, IN, USA.
Department of Urology, Southern Illinois University School of Medicine, Springfield, IL, USA.
BJU Int. 2017 Jul;120(1):104-108. doi: 10.1111/bju.13844. Epub 2017 Apr 11.
To update previously reported outcomes of modified-template post-chemotherapy retroperitoneal lymph node dissection (PC-RPLND) in appropriately selected patients with metastatic non-seminomatous germ cell tumour (NSGCT), as our previous report was criticised for short follow-up and so we now provide a long-term update on this cohort.
In all, 100 patients with normal serum markers after cisplatin-based chemotherapy and residual retroperitoneal tumour underwent modified PC-RPLND between 1991 and 2004. Using a prospectively managed institutional testicular cancer database, long-term follow-up was obtained.
As previously reported, 43 patients underwent a right-modified template, 18 patients underwent a full-left-modified template, and 39 patients underwent a left-modified template. The updated long-term median follow-up for the entire cohort is 125 months. Seven patients developed recurrent disease with a median (range) time to recurrence of 11 (6-102) months, and one patient died from recurrent disease in the chest 4 years after surgery. All recurrences were outside the boundaries of a full-bilateral template RPLND, with the most common location of recurrence being the chest. The 5- and 10-year recurrence-free survival rates were 93% and 92%, respectively. The overall survival at 10 years was 99%.
In appropriately selected patients with low-volume disease before and after chemotherapy, a modified template has durable long-term efficacy without risk of in-field recurrences at a median follow-up of 125 months.
更新先前报道的改良模板化疗后腹膜后淋巴结清扫术（PC-RPLND）在经适当选择的转移性非精原细胞瘤性生殖细胞肿瘤（NSGCT）患者中的治疗结果，因为我们之前的报告因随访时间短而受到批评，所以现在我们提供该队列的长期更新结果。
1991年至2004年间，共有100例接受以顺铂为基础的化疗后血清标志物正常且腹膜后有残留肿瘤的患者接受了改良PC-RPLND。利用前瞻性管理的机构睾丸癌数据库进行长期随访。
如先前报道，43例患者接受了右侧改良模板手术，18例患者接受了左侧完全改良模板手术，39例患者接受了左侧改良模板手术。整个队列更新后的长期中位随访时间为125个月。7例患者出现疾病复发，复发的中位（范围）时间为11（6-102）个月，1例患者在术后4年死于胸部复发性疾病。所有复发均在双侧完全模板RPLND范围之外，最常见的复发部位是胸部。5年和10年无复发生存率分别为93%和92%。10年总生存率为99%。
在化疗前后经适当选择的低负荷疾病患者中，改良模板在中位随访125个月时具有持久的长期疗效，且无野内复发风险。
