Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA.
Department of Radiology, University of Pennsylvania, Philadelphia, PA.
Urol Oncol. 2021 Feb;39(2):136.e11-136.e17. doi: 10.1016/j.urolonc.2020.11.026. Epub 2020 Dec 8.
Approximately 70% to 80% of patients with metastatic nonseminomatous germ cell tumor (NSGCT) treated with cisplatin-based chemotherapy achieve a complete response, defined as normalization of serum tumor markers and either no residual retroperitoneal mass (RRM) or an RRM <1.0 cm. While there is universal agreement that patients with an RRM ≥1.0 cm should undergo retroperitoneal lymph node dissection (RPLND), many institutions including ours recommend surveillance for patients who achieve a complete response. However, studies have not defined which axis of the RRM should be considered when deciding between surveillance and RPLND.
Good-risk metastatic NSGCT patients treated with cisplatin-based chemotherapy who achieved a complete response and underwent surveillance were identified using our institution's electronic medical records. A post-hoc review was performed by a blinded radiologist. The RRM dimensions in the transaxial short axis (TSA), transaxial long axis (TLA), and craniocaudal axis (CCA) were recorded. Differences in the frequency of recurrence between groups with an RRM <1.0 cm and ≥1.0 cm in the TLA and CCA were assessed using the Fisher exact test.
Thirty-nine patients who met study criteria were included. At a median follow-up of 63.8 months, 2 patients (5.1%) recurred. Both were successfully treated with salvage chemotherapy and RPLND. Thirteen (33%) and 27 (69%) patients had an RRM ≥1.0 cm in the TLA and CCA, respectively. There were no statistically significant differences in the risk of recurrence between patients with an RRM <1.0 cm and ≥1.0 cm in the TLA (P = 0.54) or CCA (P = 0.53).
Surveillance is an effective strategy in good-risk NSGCT patients with a postchemotherapy RRM <1.0 cm in the TSA. Our study suggests referencing the TSA and not the TLA or CCA may avoid unnecessary postchemotherapy RPLNDs.
约 70%至 80%接受顺铂为基础的化疗治疗的转移性非精原细胞瘤生殖细胞肿瘤（NSGCT）患者达到完全缓解，定义为血清肿瘤标志物正常化，并且腹膜后肿块（RRM）<1.0cm 或无残留 RRM。虽然普遍认为 RRM≥1.0cm 的患者应行腹膜后淋巴结清扫术（RPLND），但包括我们在内的许多机构建议对达到完全缓解的患者进行监测。然而，研究尚未确定在决定监测与 RPLND 之间时应考虑 RRM 的哪个轴。
使用我们机构的电子病历，确定接受顺铂为基础的化疗治疗并达到完全缓解后接受监测的低危转移性 NSGCT 患者。由一位盲法放射科医生进行事后回顾。记录 RRM 在横轴短轴（TSA）、横轴长轴（TLA）和头尾轴（CCA）的尺寸。使用 Fisher 精确检验评估 TLA 和 CCA 中 RRM<1.0cm 和≥1.0cm 组之间的复发频率差异。
符合研究标准的 39 名患者纳入研究。在中位随访 63.8 个月时，2 名患者（5.1%）复发。均成功接受挽救性化疗和 RPLND 治疗。13 名（33%）和 27 名（69%）患者在 TLA 和 CCA 中 RRM≥1.0cm。在 TLA（P=0.54）或 CCA（P=0.53）中 RRM<1.0cm 和≥1.0cm 的患者之间，复发风险无统计学差异。
在 TSA 中化疗后 RRM<1.0cm 的低危 NSGCT 患者中，监测是一种有效的策略。我们的研究表明，参考 TSA，而不是 TLA 或 CCA，可能避免不必要的化疗后 RPLND。
